Intestinal obstruction in adults due to ileal intussusception secondary to inflammatory fibroid polyp: A case report

Jejuno-jejunal intussusception following feeding jejunostomy: A case report and literature review

INTRODUCTION

Feeding jejunostomy is a rare cause of jejuno-jejunal intussusception, with presentations ranging from mild bowel obstruction to severe ischemia or perforation.

CASE PRESENTATION

A 21-year-old male with a recent history of feeding jejunostomy placement presented with acute upper abdominal pain, bilious vomiting, and inability to pass stool or flatus. Ultrasonography confirmed jejuno-jejunal intussusception, necessitating resection of the affected segment and jejuno-jejunal anastomosis. One year postoperatively, the patient remains asymptomatic with no recurrence.

DISCUSSION

Review of 17 cases of jejuno-jejunal intussusception post-jejunostomy revealed abdominal pain, vomiting, and abdominal distension as common symptoms. Diagnosis relied on imaging modalities like ultrasound or CT, and surgery was the primary treatment.

CONCLUSION

This case underscores the importance of suspicion and timely intervention to prevent complications in patients with feeding jejunostomy presenting with obstructive symptoms.

Case Report: Ileo-Ileal Intussusception Secondary to Inflammatory Fibroid Polyp: A Rare Cause of Intestinal Obstruction

Introduction

Intussusception is a telescoping of a bowel segment into another and it can be a surgical urgency. Most adult intussusceptions arise from a lead point which can be benign or malignant. For this reason, intussusception in adults should undergo surgery. Here we describe a case of ileal inflammatory fibroid polyp (IFP), presenting with ileo-ileal intussusception and obstruction.

Case report

A 54-year-old Caucasian woman presented for acute abdominal pain. A radiography and a CT of the abdomen were performed, which showed signs of occlusion due to an ileo-ileal intussusception. An urgent laparoscopy was performed, the intussusception was extracorporeally reduced, the ileal segment involved was resected, and an ileo-ileal anastomosis was performed. The intussusception seemed to be caused by a 3-cm intra-mural lesion.

Discussion

Intussusception is a surgical concern. While most cases are idiopathic in children, 90% of adult intussusceptions are caused by underlying diseases. Therefore, intussusception in adults should undergo surgery. Radiology is necessary for the diagnosis: the CT scan helps localizing the lesion and shows pathognomonic signs. This case report analyzes an intussusception caused by an inflammatory fibroid polyp. Accurate diagnosis of IFP is only possible with histopathological examination, helped by immunohistochemistry. The differential diagnosis is important because some lesions are malignant.

Conclusion

We reported a case of intussusception caused by an IFP. The diagnosis was made with a CT scan together with intraoperative findings and histopathological examination, which excluded potential differential diagnoses. The patient underwent an explorative laparoscopy, with an ileal resection and anastomosis. Due to the risk of malignancy, surgery is mandatory.

Adult Jejuno-jejunal intussusception due to inflammatory fibroid polyp: A case report and literature review

RATIONALE

Intussusception is defined as the invagination or telescoping of a proximal portion of the intestine into the distal portion of the intestine. Intussusception can occur at any age but is more common among children. Most cases of intussusception in adults have a pathological lead point. Inflammatory fibroid polyp (IFP) is a rare benign tumor-like lesion arising from the submucosa of the gastrointestinal tract that can cause intussusception in adults. Here, we report a case of adult intussusception due to IFP. We also present a literature review of 31 reports including 34 cases between 2012 and December 2019, which shows a mean age of 45.4 ± 14.2 years and female dominance (23/34) of intussusception due to IFP.

PATIENT CONCERNS

A 47-year-old man presented with a half-day history of epigastric abdominal pain. Physical examination revealed distension and tenderness of the upper abdomen. Computed tomography (CT) of the abdomen and pelvis demonstrated intussusception of the jejunum along with a suspicious jejunal mass associated with mesenteric lymphadenopathies.

DIAGNOSIS

Intussusception of the jejunum along with a suspicious jejunal mass, and histopathological examination of the resected specimen showed IFP.

INTERVENTIONS

The patient underwent emergency laparotomy. The intussusception was resected without attempts for reduction.

OUTCOMES

The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day.

LESSONS

Intussusception in adults is rare, especially that secondary to IFP. The most commonly used diagnostic tool for adult intussusception is abdominal CT, and the optimal management is resection of the involved bowel segment without reduction if malignancy cannot be ruled out.

Vanek's tumor as an unusual cause of ileo-ileal intessuception - A unique case report

BACKGROUND AND AIM

Vanek's tumor is a rare solitary lesion that is non-neoplastic, and arises from the submucosa of the gut. The most commonly affected sites are the stomach and the ileum [1]. IFP causing intestinal obstruction is uncommon and that ileo-ileal intussusception has been reported in the literature rarely. We present a case of an ileo-ileal intessuception in a patient who presented with acute on chronic pain abdomen and anorexia. CT abdomen & pelvis revealed a 46 × 36 mm intraluminal mass in the left iliac fossa causing ileo-ileal intussusception.

CASE PRESENTATION

A 60 years old gentleman was brought to the A&E with a history of intestinal obstruction. He was examined and admitted to the surgical unit. CBC revealed unique feature of reactive thrombocytosis apart from a low hemoglobin and a raised TLC. His CT scan demonstrated findings of ileo-ileal intussusception. After an informed written consent, patient underwent an exploratory laparotomy and had resection and anastomosis of the bowel. Histopathology of the specimen revealed findings compatible with IFP. Patient made an uneventful recovery post-operatively and was sent home in the next few days. On follow-up, the patient was doing well and had no complaints of abdominal pain or anorexia.

CONCLUSION

Vanek's tumor although a rare entity, should be considered in each case of acute abdomen and physicians and surgeons need to have a high degree of suspicion in such cases. Moreover, IFP can cause reactive thrombocytosis that gets resolved after a post-operative period of 6-8 weeks.

A Surgical Conundrum in Feeding Jejunostomy-Jejunojejunal Intussusception: A Case Series

Intussusception is a common cause of intestinal obstruction in the pediatric population. Usually, it is primary and benign and can be managed by nonoperative interventions in 80% of the cases. Adult intussusception accounts for only 5% of all cases of intussusception and 1%–5% of all cases of intestinal obstruction. Unlike in the pediatric population, intussusception in adults is usually caused by a pathologic lead point. The initial investigation to diagnose it is an ultrasound abdomen followed by contrast-enhanced computed tomography (CECT) of the abdomen. The placement of an intestinal tube for feeding purposes has been rarely reported as a cause of intussusception. Here, we present a case series of four patients who had jejunojejunal intussusception following the placement of feeding tubes into the jejunum. Three patients were operatively managed and one was managed conservatively.

An Unusual Cause of Intestinal Obstruction in a Young Adult Patient: Inflammatory Fibroid Polyp

Inflammatory fibroid polyps are uncommon benign lesions that originate in the submucosa of the gastrointestinal tract. The stomach and the ileum are the most commonly affected sites. Although inflammatory fibroid polyp is one of the rare conditions leading to intestinal obstruction in adults, it should be considered as a possible diagnosis in obstructive tumors of the small bowel causing intussusceptions. We present one case of inflammatory fibroid polyp as a rare cause of intussusception in a young adult patient.