A Resected Case of Carcinoma of the Pancreatic Tail Presenting as Jejunal Ileus

A 72-year-old man undergoing total gastrectomy with splenectomy for gastric cancer at age 56 and reporting epigastric pain was admitted under a diagnosis of ileus. Enterography through an ileus tube showed complete obstruction of the jejunum, necessitating laparotomy for suspected adhesive ileus. A tumor about 5 cm in diameter was found in the pancreatic tail and directly involved the jejunum through the transverse mesocolon. We conducted distal pancreatectomy with left adrenalectomy and partial resection of the jejunum and the transverse colon. The tumor was diagnosed as moderately differentiated tubular adenocarcinoma of the pancreatic tail with direct invasion to the jejunum and the left adrenal gland. Pathological staging was IVa. Because recurrence in the paraaortic lymph node occurred 3 months postoperatively, we conducted systemic chemotherapy with gemcitabine resulting in long NC during follow-up 13 months postoperatively. Pancreatic cancer presenting as ileus is extremely rare, and only 10 cases, including ours, have been reported in Japan. Ours is also the first with jejunal obstruction. Pancreatic cancer must thus be kept in mind as a possible differential diagnosis in obstruction of the small intestine.