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A RARE CASE REPORT OF RECURRENT INFLAMMATORY FIBROID POLYP IN THE ILEUM. Gastroenterol Nurs 2022; 45:454-458. [PMID: 35877955 DOI: 10.1097/sga.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/24/2022] [Indexed: 01/20/2023] Open
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Guerci C, Colombo F, Goi G, Zerbi P, Pirrò B, Danelli P. Case Report: Ileo-Ileal Intussusception Secondary to Inflammatory Fibroid Polyp: A Rare Cause of Intestinal Obstruction. Front Surg 2022; 9:876396. [PMID: 35495766 PMCID: PMC9051068 DOI: 10.3389/fsurg.2022.876396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Claudio Guerci
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Claudio Guerci ;
| | - Francesco Colombo
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
- Francesco Colombo
| | - Gloria Goi
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Pietro Zerbi
- Pathology Unit, Department of Biomedical and Clinical Sciences “L. Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Barbara Pirrò
- Department of Radiology, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Piergiorgio Danelli
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
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Garmpis N, Damaskos C, Garmpi A, Georgakopoulou VE, Sakellariou S, Liakea A, Schizas D, Diamantis E, Farmaki P, Voutyritsa E, Syllaios A, Patsouras A, Sypsa G, Agorogianni A, Stelianidi A, Antoniou EA, Kontzoglou K, Trakas N, Dimitroulis D. Inflammatory Fibroid Polyp of the Gastrointestinal Tract: A Systematic Review for a Benign Tumor. In Vivo 2021; 35:81-93. [PMID: 33402453 DOI: 10.21873/invivo.12235] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM Inflammatory fibroid polyp (IFP) is a rare, usually solitary and intraluminal polypoid benign tumor that can affect any part of the gastrointestinal (GI) tract, although in the majority of cases it affects the stomach. This lesion is characterized by proliferation of highly vascular fibrous tissue and infiltration by a variable number of different inflammatory cells. Its etiology is unknown. Our aim was to describe all the reported data concerning IFP. MATERIALS AND METHODS An extensive search of the PubMed Index was performed for publications with titles or abstracts containing the terms: "inflammatory fibroid polyp" with/without "Vanek". Results were filtered for publications in English and concerning only humans. One hundred and twenty-four publications were finally included in this review. RESULTS IFP has a female predominance. It affects patients in their 5th decade of life, although there are cases of patients from 4 to 84 years of age. IFP usually affects the stomach and more specifically the gastric antrum but can be detected throughout the GI tract. A significant number of cases remain asymptomatic but the most frequent presentations of IFP are abdominal pain, acute abdomen and GI bleeding. Most cases are treated by endoscopic resection of the lesion. No recurrence nor IFP-specific complications have been reported. Histopathology of IFP varies. CONCLUSION It is relatively safe to conclude that both the etiology and the timing of diagnosis might change the histopathology, immunohistological staining and tissue structure of IFP. Suggested theories should be taken into consideration with caution as the etiology and pathophysiological mechanisms of IFP are unknown.
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Affiliation(s)
- Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece; .,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki E Georgakopoulou
- Department of Pulmonology, Laiko General Hospital, Athens, Greece.,First Department of Pulmonology, Sismanogleio Hospital, Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aliki Liakea
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Diamantis
- Department of Endocrinology and Diabetes Center, G. Gennimatas General Hospital, Athens, Greece
| | - Paraskevi Farmaki
- First Department of Pediatrics, Agia Sofia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Errika Voutyritsa
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Patsouras
- Second Department of Internal Medicine, Tzanio General Hospital, Piraeus, Greece
| | - Georgia Sypsa
- Department of Pulmonology, Laiko General Hospital, Athens, Greece
| | | | - Athanasia Stelianidi
- First Department of Pediatrics, Agia Sofia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios A Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kao YK, Chen JH. Adult Jejuno-jejunal intussusception due to inflammatory fibroid polyp: A case report and literature review. Medicine (Baltimore) 2020; 99:e22080. [PMID: 32899081 PMCID: PMC7478680 DOI: 10.1097/md.0000000000022080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
| | - Jian-Han Chen
- Bariatric and Metabolism International Surgery Center
- Division of General Surgery, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Albabtain I, Arishi H, Albaghli S, Aljahani J. Inflammatory fibroid polyps of the appendix: different presentation and literature review. J Surg Case Rep 2018; 2018:rjy200. [PMID: 30151103 PMCID: PMC6101586 DOI: 10.1093/jscr/rjy200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023] Open
Abstract
Inflammatory fibroid polyps (IFPs), or Vanek’s tumor, are rare benign mesenchymal lesions of the gastrointestinal tract (GIT). IFPs can be found throughout the GIT but most frequently in gastric antrum or ileum, with the appendix accounting for only <1% of all IFPs. The clinical presentation is usually vague yet depends on the location. We report a case of 50-year-old healthy male presented to the emergency department with a sub-acute complaint of non-specific abdominal pain, which was suspected to be appendicitis. Abdominal CT scan was done as well as colonoscopy and histopathology were scheduled. A week later, he presented in the clinic, still complaining of abdominal pain; thus, the decision was made to schedule him for laparoscopy with appendectomy. Finally, the post-operative course was unremarkable and the patient was discharged home. This is a rare case of IFPs originating in the appendix presenting as an atypical sub-acute appendicitis.
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Affiliation(s)
- Ibrahim Albabtain
- Division of Trauma & Acute Care, Department of Surgery, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hassan Arishi
- Department of Surgery, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Slava Albaghli
- Department of Pathology, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jumanah Aljahani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Inflammatory Fibroid Polyp: An Unusual Cause of Ileoileal Intussusception. Case Rep Surg 2017; 2017:6315934. [PMID: 29348960 PMCID: PMC5733754 DOI: 10.1155/2017/6315934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023] Open
Abstract
Inflammatory fibroid polyp (IFP), or Vanek's tumor, is a rare benign lesion of the gastrointestinal tract. Clinical manifestations of IFP vary based on size and location within the GI tract. This case describes a patient who presented with hematochezia and abdominal pain. Computed tomography revealed ileoileal intussusception without a clear lead point. The patient underwent resection of the intussuscepted small bowel with primary anastomosis. A large polypoid mass was identified as the pathological lead point. Histopathological and immunohistochemical analysis revealed an IFP. Review of the literature indicates that early surgical intervention is the treatment of choice for intussusception caused by IFP. Lesions are typically reported as solitary, and resection is curative.
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Demir MK, Savas Y, Furuncuoglu Y, Cevher T, Demiral S, Tabandeh B, Aslan M. Imaging Findings of the Unusual Presentations, Associations and Clinical Mimics of Acute Appendicitis. Eurasian J Med 2017; 49:198-203. [PMID: 29123444 DOI: 10.5152/eurasianjmed.2017.17218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There are many kinds of unusual presentations or associations and clinical mimics of acute appendicitis, and definitive diagnosis requires knowledge of the imaging findings in some cases. The unusual presentations and associations of acute appendicitis included in this study are perforated appendicitis, acute appendicitis occurring in hernias, acute appendicitis with cystic endosalpingiosis, intussusception of appendix, and acute appendicitis with pregnancy. We also present uncommon gastrointestinal, urinary and gynecologic clinical mimics of acute appendicitis including anomalous congenital band, duplication cysts, giant Meckel's diverticulitis, inflammatory fibroid polyp, renal artery thrombosis, spontaneous urinary extravasation and OHVIRA syndrome. Familiarity with these entities may improve diagnostic accuracy and enable the quickest and most appropriate clinical management.
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Affiliation(s)
- Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Yildiray Savas
- Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Yavuz Furuncuoglu
- Department of Internal Medicine, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Tarik Cevher
- Department of Surgery, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Serdar Demiral
- Department of Surgery, Atakent Acıbadem Hospital, İstanbul, Turkey
| | - Babek Tabandeh
- Department of Surgery, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Melisa Aslan
- Medical Student, Bahcesehir University School of Medicine, İstanbul, Turkey
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Shim EJ, Ahn SE, Lee DH, Park SJ, Kim YW. Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach. World J Gastroenterol 2017; 23:2090-2094. [PMID: 28373777 PMCID: PMC5360652 DOI: 10.3748/wjg.v23.i11.2090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/01/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
Inflammatory fibroid polyp (IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography (CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.
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Han GJ, Kim JH, Lee SS, Park SH, Lee JS, Ha HK. Inflammatory fibroid polyps of the gastrointestinal tract: a 14-year CT study at a single institution. ACTA ACUST UNITED AC 2016; 40:2159-66. [PMID: 25896613 DOI: 10.1007/s00261-015-0431-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the computed tomography (CT) features of pathology-proven inflammatory fibroid polyps (IFPs) in the gastrointestinal tract. METHODS This retrospective series study included 27 patients with pathology-proven IFPs in the stomach (n = 16), small (n = 9), and large (n = 2) intestine, who underwent contrast-enhanced CT. Two radiologists reviewed the CT images of the patients to determine in consensus the long diameter, shape, margin, contour, and growth pattern of the lesions, the presence of an ulcer and overlying mucosal hyperenhancement, the lesion enhancement patterns including the homogeneity and the degree of contrast enhancement, and the presence of intussusception and obstruction. The CT results and clinical data of the gastric and intestinal lesions were compared. RESULTS The IFPs typically manifested as well-defined (89%), round or ovoid (81%), slightly lobulated-contoured (70%) masses with a purely endoluminal growth pattern (96%) and an overlying mucosal hyperenhancement (67%). Lesion homogeneity and the degree of contrast enhancement varied. The intestinal IFPs were significantly larger (3.5 vs. 2 cm), more symptomatic (82% vs. 19%), and more frequently associated with intussusception (73% vs. 0%) and obstruction (46% vs. 6%) than the gastric lesions (p ≤ 0.027). CONCLUSIONS The characteristic CT features of IFPs were well-defined, round or ovoid, lobulated-contoured, and endoluminal masses with overlying mucosal hyperenhancement and various enhancement patterns. IFP should be included in the differential diagnosis of patients with a soft-tissue mass in the gastrointestinal tract, especially if a large endoluminal mass in the small intestine is accompanied by intussusception.
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Affiliation(s)
- Ga Jin Han
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea.
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Jong Seok Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
| | - Hyun Kwon Ha
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea
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