Case 166

 A forty nine-year-old male presented in our hospital for the follow-up to check recurrent tumor or metastatic tumor from rectal cancer. Seven years ago, he had received the surgical resection of rectal cancer with artificial anus formation in the university hospital. He was introduced to us for the follow-up after malignant tumor management because he lived with his family in our city. He had epilepsy since he was two-year-old and he had intellectual disability. His parents are alive. His family history is as follows; father’s eldest brother, unknown cancer death, father’s elder brother, colon cancer, father’s elder sister, colon cancer: mother’s mother, skin cancer, mother’s father, ureter cancer, mother’s two younger brothers, gastric cancer.
 Recently, he experienced vomiting twice a month. Laboratory test revealed CRP 0.17 mg/dL, white blood cells 5890/mm3, CEA 1.5 ng/mL. He underwent non-enhanced CT (Fig.1) which showed no evidence of recurrence or metastasis, but there was dietary content in the lumen of the duodenum end. Gastric endoscopic examination showed chronic gastritis. Colon endoscopic examination showed no evidence of recurrent tumor.
 Three months later, the incidence of vomiting getting increased once a week to once a day. His body weight decreased from 77 kg to 70 kg. He underwent non-enhanced CT again (Figs. 2 – 4).

What is your diagnosis ?

1.　Anisakis duodenitis

2.　Dietary ileus

3.　Duodenal cancer

4.　Duodenal Tbc

5.　Superior mesenteric artery syndrome

answer

2019.10.16