Small bowel obstruction is a common reason for hospital admission and is most frequently caused by postoperative adhesions. Malignancy is a less common etiology and typically results from a focal obstructing lesion. We present the case of a 67-year-old female who developed small bowel obstruction due to diffuse sarcomatous implants throughout the abdomen and pelvis. Computed tomography demonstrated dilated small bowel with a pelvic transition point. After failure of conservative management, the patient underwent surgical exploration, which revealed hundreds of small malignant lesions involving the small bowel, omentum, and peritoneum, resulting in bowel fixation and obstruction. The obstructed segment of small bowel was resected, and a diverting loop colostomy was created because of impending obstruction at the affected rectum. Pathology revealed a high-grade, poorly differentiated sarcomatous malignancy. This case highlights a rare malignant cause of small bowel obstruction and emphasizes the importance of considering underlying malignancy in patients who fail non-operative management, particularly those with prior oncologic risk factors.
Ponce et al. (Mon,) studied this question.