Jejunojejunal intussusception caused by a jejunal gastrointestinal stromal tumour (GIST)
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CASE REPORT
Jejunojejunal Intussusception Caused by a Jejunal Gastrointestinal Stromal Tumour (GIST) Arghya Basu, Manas Kumar Dutta, Utpal De, Soumika Biswas
Abstract Introduction: Adult intussusception represents a challenge to the surgeon as it can cause acute, subacute or chronic
non-specific obstruction and presents with dubious clinical features. Case Report: A forty-six-year-old female presented with progressively worsening abdominal pain, mild abdominal
distension, anorexia, profuse vomiting and constipation that had begun thirty six hours earlier. Discussion: Primary or metastatic malignancies are responsible for 14 – 47% of all small bowel intussusceptions; in the large bowel 66% of cases have malignant aetiology. In contrast, abdominal X-rays display an intussusception as stacked coins or a coiled spring in the upper GI series and cup–shaped defect in contrast enema. The treatment of choice in adult intussusception is always surgical. Conclusion: Adult intussusception is a rare entity that may present a diagnostic dilemma due to its non-specific symptoms. However, controversy surrounds the need for reduction and extent of surgical resection. Key words: Itussusception, Jejunum, Stromal Tumour, GIST
Introduction Intussusception is the invagination or telescoping of one portion of the intestine (intussusceptum) into an adjacent segment (intussuscipiens) that can often present as a lifethreatening emergency, frequently instigating strangulation of the gut, leading to gangrene and perforation. It is the leading cause of infantile intestinal obstruction, but in adults the incidence is only 1% of all intestinal obstructions and 0.003-0.02% of all adult hospital admissions [1]. Among children, intussusception is idiopathic in 90% of cases and secondary to hyperplasia of gut lymphoid tissue (following viral infection), whereas 10% have a pathological lead point like Meckel’s diverticulum, polyp, enteric cysts, appendix or Arghya Basu, MBBS (HONS.), MS (General Surgery) PGT, Dept. of General Surgery, Medical College, Kolkata, West Bengal, India, Manas Kumar Dutta, MBBS, MS (General Surgery), FMAS, Emergency Surgeon, Dept. of General Surgery, Medical College, Kolkata, West Bengal, India Utpal De, MBBS, MS (General Surgery), Professor, Dept. of General Surgery, Medical College, Kolkata, West Bengal, India Soumika Biswas, MBBS, MD (Biochemistry) PGT, Dept. of Biochemistry, Medical College and Hospital, Kolkata,West Bengal, India Corresponding author: A. Basu 26A, Keshab Chandra Sen Street. West Bengal, India Postal Code: 700009, Tel.: +919051202232, +919477116161 E-mail: [email protected], [email protected] Received 7 July 2013; Accepted 8 August 2013 Hellenic Journal of Surgery 86
lymphoma. In contrast, 90% of adult cases have a specific pathological lead point, 65% of which are caused by a polyp, submucosal lipoma or a neoplastic mass [2]. Adult intussusception poses a challenge to the surgeon as it can cause acute, subacute or chronic non-specific obstruction and presents with dubious clinical
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