DOI: https://doi.org/10.36347/sasjs.2026.v12i11.008

Pages: 932-935

Introduction: Small bowel adenocarcinoma is a rare malignancy, accounting for less than 5% of gastrointestinal cancers. Its nonspecific symptoms delay diagnosis, and it is often revealed by a complication. Presentation with tumor perforation and generalized peritonitis is uncommon. Case presentation: A 60-year-old man with a history of hypertension was admitted to the emergency department with a two-day history of bowel obstruction, with cessation of stool and gas, vomiting, diffuse abdominal pain and fever. He was tachycardic, and his distended abdomen showed guarding. Laboratory tests revealed leukocytosis and an elevated C-reactive protein. Abdominopelvic computed tomography showed a large small bowel mass with peritoneal effusion and free air. After resuscitation and antibiotic therapy, emergency laparotomy revealed a huge perforated small bowel tumor infiltrating its mesentery and invading adjacent loops, with enteric peritoneal fluid. An en bloc segmental resection was performed with margins of more than 5 cm and a triangular resection of the mesentery, followed by a side-to-side small bowel anastomosis, peritoneal lavage and drainage. The postoperative course was uneventful and the patient was discharged on postoperative day 6. Histopathology showed a small bowel adenocarcinoma with tumor-free proximal and distal margins and several metastatic lymph nodes. The patient was referred for adjuvant chemotherapy and was doing well at one month. Conclusion: Small bowel adenocarcinoma may present as a surgical emergency. Oncological en bloc resection remains feasible in this setting.