Expecting the Unexpected: Adenocarcinoma of Duodenojejunal Flexure in a 15-Year-Old

A 15-year-old female patient presented to emergency with bilious vomiting after taking meals for the last 3 months along with intermittent colicky pain in the epigastrium for the last 1 month. Initially, the frequency of vomiting was 2–3 times/week which gradually increased to 4–5 times/day in the last 2 weeks. She had no history of any abdominal pathology or past history of tuberculosis or abdominal surgery. A review of systems showed she had a weight loss of about 10 kgs in the last 3 months along with loss of appetite. Physical examination revealed soft distention of the upper abdomen with mild tenderness in the epigastrium. CT scan of the abdomen showed concentric heterogenous luminal narrowing near duodenojejunal flexure with gross dilatation of the duodenum and stomach. The patient underwent resection of D4 and proximal jejunum with side-to-side D2-jejunum anastomosis. Histopathological examination revealed the luminal lesion to be an adenocarcinoma.