Ileal Perforation and Cervical Nodal Metastasis in Small Bowel Adenocarcinoma: A Case Report

Abstract

Small bowel adenocarcinoma (SBA) is a rare malignancy that typically presents late and is difficult to diagnose, particularly when arising in the ileum. We report an exceptional case of SBA presenting simultaneously with ileal perforation and cervical lymph node metastasis - two manifestations that are individually uncommon and exceedingly rare in combination. A 69-year-old woman presented with an acute abdomen and a newly enlarged cervical lymph node; laparoscopy revealed a 2-mm ileal perforation with peritoneal nodules, and subsequent cervical node excision confirmed metastatic carcinoma. Histopathology and immunohistochemistry demonstrated CK7 and EMA positivity with CK20 negativity, supporting the diagnosis of SBA and excluding colorectal, neuroendocrine, and stromal neoplasms. This unusual presentation highlights the diagnostic challenges posed by ileal tumors, underscores the critical role of timely surgical exploration, and emphasizes the importance of immunohistochemistry in establishing tumor origin when clinical and radiologic findings are ambiguous.