Presentation
Abdominal pain, dyspepsia and vomiting.
Patient Data
Large paraesophageal hernia is present and proximal two third of stomach is herniated into thorax. Passive parenchymal collapse is noted at bilateral lower lobes. There are also several atelectatic bands scattered bilaterally.
Duodenal loops are distended and focal increased wall thickness is noted at proximal of jejunum accompanied by adjacent fat stranding. There are also several lymphadenopathies with maximum SAD of 20 mm in the vicinity of diseased segment.
Multiple ill-defined low enhancing masses are seen at liver less than 80 mm.
Several non-enhanced simple cortical cysts are seen at both kidneys, with maximum diameters of 40 mm. A few small parapelvic cysts are also observed bilaterally.
The prostate gland is enlarged.
Degenerative changes as osteophytosis are seen at the lumbar spine.
Grade I spondylolisthesis of L5 on S1 is present with bilateral spondylolysis.
Fat containing left inguinal hernia is present.
Case Discussion
Jejunal mass; pathology proven adenocarcinoma; with regional lymphadenopathies and hepatic metastasis. Jejunal adenocarcinoma, a small bowel adenocarcinoma (SBA), is a rare cause of small bowel obstruction
Large paraesophageal hernia is also evident which is an uncommon type of hiatal hernia representing ~10% of all hiatal hernias.
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