An uncommon cause of small bowel obstruction: isolated primary granulocytic sarcoma

Abstract

A 55-year-old woman was admitted with a 10-day history of colicky, left lower-quadrant abdominal pain and intermittent vomiting. She also reported a 2-month history of alternating diarrhea and constipation, with a 20-pound weight loss. She denied malena or hematemesis. She had a 40-pack year history of smoking. On admission, she was normotensive, tachycardic and appeared dehydrated. Generalized abdominal tenderness was noted on palpation, with hyperactive bowel sounds and no guarding or rigidity. There was no palpable lymphadenopathy. The remainder physical examination was unremarkable. Laboratory examination including a complete blood count, Erythrocyte sedimentation rate, liver and renal profile were normal. Stool was positive for occult blood with negative cultures. Multiple air fluid levels were noted on an upright abdominal radiograph. A computerized tomogram (CT) of the abdomen (Figure 1) demonstrated irregular thickened loops of small bowel with a mesenteric mass, suggestive of a primary mesenteric or small bowel tumor. The diagnosis of mechanical small bowel obstruction prompted an explorative laparotomy, which revealed multiple nodular masses in mesentery and small bowel causing luminal narrowing. A wedge resection of the small bowel was undertaken to relieve obstruction.