Laparoscopy and intraoperative enteroscopy, a helpful tool in a rare tumor (inflammatory fibroid polyp) of the small bowel. A case report

A rare case of bleeding jejunal ulcer diagnosed by intraoperative use of enteroscopy

INTRODUCTION

Small bowel bleeding can be overt or occult. Despite advances in imaging and endoscopy, the diagnosis and treatment of small bowel bleeding remain challenging due to its length and location. Diagnostic procedures such as push enteroscopy, capsule endoscopy and intraoperative enteroscopy are recommended to identify the source of bleeding.

CASE PRESENTATION

A 33-year-old female with no prior history of bleeding diathesis presented with massive lower GI bleeding. Although she was in hypovolemic shock from bleeding, physical exam, splanchnic angiography and colonoscopy were unable to localize the source of bleeding. The patient continued to bleed and deteriorate despite transfusions. Exploratory laparotomy was done but localizing the source with manual palpation of small bowel was difficult. Intraoperative enteroscopy was done and showed a 2 by 1 cm ulcerative lesion at mid jejunum. Part of jejunum containing the ulcer was resected and anastomosis done. The patient did well postoperatively and on follow up.

CLINICAL DISCUSSION

A bleeding primary jejunal ulcer is rare clinical scenario difficult to diagnose. Intraoperative enteroscopy is useful in cases where initial diagnostic workups are inconclusive. It can be performed using various types of endoscopes, such as a standard or pediatric colonoscope, push enteroscope, or a sonde enteroscope, during laparotomy.

CONCLUSION

Primary jejunal ulcer is a rare cause of massive lower GI bleeding. Although minimally invasive deep endoscopic techniques to diagnose small bowel ulcers are evolving, intraoperative enteroscopy remains to be technically easy and helpful tool to make a diagnosis and guide intervention especially in a patient undergoing laparotomy for bleeding small bowel ulcer.

Intussusception in an adult revealing a Vanek's tumor: A case report

INTRODUCTION AND IMPORTANCE

Inflammatory fibroid tumors (IFT) or Vanek's tumors are scarce benign neoplasms. They can affect any part of the digestive tract. They are underdiagnosed conditions that are generally revealed by a life-threatening complication such as intussusception. The final diagnosis is set on the resection specimen after curative surgery.

CASE PRESENTATION

A 35-year-old patient presented with an acute small bowel occlusion related with an ileo-ileal intussusception revealed by an emergency CT-scan. The etiology of the occlusion wasn't clear but we suspected a complicated malignant tumor of the small bowel. Therefore, an emergency surgery was performed and we resected the tumor with margins. The diagnosis of Vanek's tumor was set at the pathology examination.

DISCUSSION

Inflammatory fibroid tumors are mesenchymal tumors with no malignant potential. However, they can be revealed by a dangerous complication leading to an emergency surgery. Complete resection is required and pathology examination set the diagnosis.

CONCLUSION

Surgeons should include IFT among the several differential diagnosis of ileal intussusception of the adults as it mimics other small bowel tumors. Only pathology examination can set the diagnosis.