Unusual case of small bowel intussusception in adult revealing a Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is a rare genetic disorder characterized by hyperpigmented mucocutaneous macules, hamartomatous polyps of the small intestine, and family history. These hamartomatous polyps can cause intermittent abdominal pain, chronic anemia, or even intussusception. Imaging has an important role in the diagnosis of this syndrome but also in the identification of complications and periodic surveillance. Here we present a demonstrative case of a Peutz-Jeghers syndrome associated with intussusception in a 16-year-old patient.

Small Bowel Intussusception Due to Rare Cardiac Intimal Sarcoma Metastasis: A Case Report

Background: Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation. Intussusception is an unusual event in adults, accounting for <5% of bowel obstructions. In most cases it is caused by a malignancy and requires surgical resection.Case Presentation: We describe a rare case of a 50-year-old man suffering of bowel obstruction due to intussusception sustained by a small bowel metastasis of a primary cardiac intimal sarcoma. One year and a half before the onset of abdominal symptoms, a grade II intimal sarcoma was removed from his left atrium and consequently he followed a chemotherapy protocol. Four months later a CT scan revealed local recurrence. Eighteen months after heart surgery he referred to the ER with abdominal pain. CT scan showed an ileal intussusception and the patient was scheduled for surgery. A tract of 10 cm ileus was removed containing an intramural polypoid solid mass. Histological analyses revealed a grade II intimal sarcoma consistent with his first diagnosis.Conclusion: Primary heart tumors are late found and often partially resected, therefore metastatic pathways are to be expected. Adult small bowel intussusception is a rare event and caused by a malignancy in one third of cases. Therefore, our recommendation is to always resect the tract involved in order to perform a proper diagnosis.

EP.FRI.543 A rare case of acute jejuno-jenual intussusception in a patient with Roux-en-Y bypass secondary to a benign polyp

Introduction Roux-en-Y Gastric bypass (REYGB) amounts for a third of surgical bariatric interventions. Small bowel obstruction (SBO) is a long-term complication in REYGB and can be caused by intussusception of bowel, in approximately 0.5% of procedures. Intussusception in REYBG is mostly attributed to dysmotility. This report demonstrates a rare case of intussusception in REYGB secondary to a benign polyp. Case description A 45 year old female, three years post REYGB, presented to A&E with acute, extreme upper abdominal pain, with three days absolute constipation. She was tender on examination with normal blood tests. CT scan demonstrated small bowel intussusception. Initial concerns were of intussusception of the jejuno-jejunostomy anastomosis causing SBO. She had an exploratory laparotomy, which confirmed intussusception, however this was 20cm distal to the jejuno-jejunostomy. Bowel was gently reduced, and deemed viable. On thorough run-through, a small segment at the transition point, was considered abnormal on palpation. This region was resected and a 1x1cm intraluminal polyp was identified as the causative lead point. The patient did well postoperatively. Discussion Small bowel intussusception in adults is typically attributed to pathological lead point, such as benign or malignant lesions. Intussusception in REYBG is a rare but well-documented cause of intestinal obstruction, usually attributed to dysmotility, secondary to ectopic pacemaker cells particularly around anastomoses. In this case, the intussusception was caused by an unusual pathology separate from the jejuno-jejunal anastomosis. We recommend thorough examination of all adjacent bowel to exclude lesions, in this case a polyp, which could result in recurrence.

Submucosal Lipoma at the lead point of Small bowel Intussusception in an Adult

Introduction/Objective Morbidity and mortality among adult patients presenting with acute abdominal pain are high, and these patients often require hospitalization with prompt surgical consultation Important differentials include small bowel obstruction from previous surgeries and hernias, acute mesenteric ischemia, and ruptured abdominal aortic aneurysm. Intussusception in adults is rare accounting for about 1% - 5% of small bowel obstructions and thus requiring a high index of suspicion for early detection. In most cases, the lead point is a benign mass, commonly a lipoma, but histopathologic examination of the resected segment is required to rule out malignancy. Methods/Case Report We present a case of a 50-year old male with a medical history of psoriasis and hypertension who was admitted on account of a 1-day history of sudden onset persistent abdominal pain with associated nausea non-bilious emesis. Physical examination reveals no fever and soft non-distended abdomen with diffuse tenderness. CT scan demonstrated long segment small bowel-small bowel intussusception with markedly edematous and dilated bowel, compatible with obstruction. The lead-point was suspected to be a 3.9cm lipoma. Segmental resection and primary re-anastomosis were performed. Gross examination revealed a 13cm segment of bowel telescoping into a distal segment with a lead-point demonstrating mucosal congestion and submucosal thickening corresponding to a well-circumscribed 3.5cm tan yellow soft lobulated mass with yellow cut surface. Histopathology was consistent with lipoma. The patient made an uneventful postoperative recovery. Results (if a Case Study enter NA) N/A Conclusion Intussusception should be kept in the differential diagnosis of adults presenting with sudden onset abdominal pain and pathologic examination of the resected segment is necessary to rule out malignancy.