Ileal metastasis of a Colorectal Carcinoma in an asymptomatic patient confirmed by Single-Balloon Enteroscopy

摘要

To the Editor, Malignant neoplasms of the small bowel are unusual and often constitute a diagnostic and therapeutic challenge. Metastatic small bowel lesions, which are extremely uncommon, usually arise from lung, breast or gastric cancer; metastases originating from a primary colon cancer are particularly rare (1). Involvement of the small bowel usually occurs due to local invasion or peritoneal dissemination, rarely emerging from a direct hematogenous route (1). Small intestine metastases are usually revealed through bowel obstruction or bleeding, being rarely asymptomatic; hence, diagnosis almost always occurs during surgical procedures in an emergency setting (2). In asymptomatic patients, whose lesions are identified preoperatively, the diagnosis can be particularly defiant. We present the case of a female patient with a past history of colorectal carcinoma who developed a small bowel metastasis while asymptomatic. Balloon-assisted enteroscopy had a crucial role since it allowed prompt recognition and characterization of the lesion, thus enabling a proper therapeutic strategy which included preoperative chemotherapy.