Jejunojejunal intussusception induced by a gastrointestinal stromal tumor. Case Rep Surg. 2012;2012:173680. [PMID: 23213593 PMCID: PMC3506898 DOI: 10.1155/2012/173680]

Adult Jejunojejunal Intussusception Caused by Small Bowel Leiomyoma

This article reports a case of a patient with intestinal obstruction admitted to the hospital whose presumed diagnosis by CT was jejunojejunal intussusception. The patient underwent exploratory laparotomy with an enterectomy of the invaginated segment. The histopathological and immunohistochemical results of the surgical specimen confirmed the presence of a small bowel leiomyoma. This case highlights the importance of a detailed clinical evaluation of patients with an intestinal obstruction who seek emergency care. The cause of intestinal obstruction is a diagnostic challenge due to the numerous pathologies that can lead to the development of the condition. Guided anamnesis, detailed physical examinations, and accurate subsidiary exams that do not delay diagnosis are the cornerstones of emergency room care. Knowing the ideal time to refer the patient to the operating room requires knowledge and practice. The patient reported in this article with jejunal leiomyoma as a cause of intestinal intussusception is surprising for its rarity and illustrates the range of pathologies that can lead to intestinal obstruction.

Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review

Intussusception is defined as the invagination of a proximal segment of the bowel into the adjoining or distal segment. In most adults with intussusception, there is a demonstrable lead point with a definite pathologic abnormality. The clinical features of intussusception include chronic intermittent abdominal pain, nausea and vomiting, constipation, and a palpable abdominal mass. The present case report describes a 62-year-old woman with a 2-week history of abdominal pain and 9-day history of vomiting. Clinical, imaging, and histologic evaluations revealed a jejunojejunal intussusception with a gastrointestinal stromal tumor as the lead point. A gastrointestinal stromal tumor should be considered as a possible lead point in adult patients with intussusception. The implication of reducing the intussusception prior to tumor resection requires further evaluation in view of the risk of venous embolism, including direct spread of malignant cells, in cases involving a large polypoid mass with a necrotic surface that extends to the serosa as shown by intraoperative examination. Accordingly, the rationale for adjuvant therapy with imatinib also requires further evaluation.

Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor: A case report and review of the literature

BACKGROUND

Gastric gastrointestinal stromal tumor (GIST) is the most common etiology of gastroduodenal intussusception. Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection, the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection (ESD) in Japan in 2017.

CASE SUMMARY

An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month. Initially, she visited a local clinic for help, where abdominal sonography revealed a space-occupying lesion around the liver, so she was referred to our hospital for further confirmation. Abdominal sonography was repeated, which revealed a mass with an alternating concentric echogenic lesion. Esophagogastroduodenoscopy (EGD) was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet. EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found. Several differential diagnoses were suspected, including gastroduodenal intussusception, gastric cancer invasion to the duodenum, or pancreatic cancer with adherence to the gastric antrum and duodenum. Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb. Under the impression of gastroduodenal intussusception, ESD was performed at the base of the gastroduodenal intussusception; unfortunately, a gastric perforation was found after complete resection was accomplished, so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion. The gastric tumor was pathologically proved to be a GIST. After the operation, there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation.

CONCLUSION

We present the second case of gastroduodenal intussusception caused by GIST treated by ESD. It is also the first case report of gastroduodenal intussusception by GIST in Taiwan, and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.

Life-threatening bleeding with intussusception due to gastrointestinal stromal tumor: a case report

Background

Massive intraluminal bleeding requires urgent intervention and management. However, the source of bleeding on the small intestine is difficult to determine. Intestinal tumor with intussusception is a rare and normally not an urgent condition. Herein, we present a rare case of intestinal intussusception with massive bleeding due to jejunal gastrointestinal stromal tumor (GIST) that required emergency surgical treatment.

Case presentation

A 51-year-old male was admitted to the emergency department complaining of abdominal pain and acute hematochezia. Esophagogastroduodenoscopy (EGD) and colonoscopy could not determine the source of the bleeding site. Abdominal pelvic computed tomography (AP-CT) revealed GIST with intussusception, strongly suggestive of distal jejunal bleeding. Unresponsive transfusion with low blood pressure and continuous hematochezia led to emergency laparotomy. GIST, which was the leading point for intussusception, was located in the jejunum and showed mucosal ulceration of approximately 3.5 cm in diameter. Following resection and functional anastomosis, histology revealed a GIST with low mitotic count (< 5 per 50HPF). Moreover, immunochemical analysis revealed positivity for c-kit (CD117) and DOG-1. There were no complications 2 months after surgery.

Conclusions

Intussusception associated with GIST is a rare finding that can be life-threatening if it occurs with an ulcer. This case showed that the early detection of bleeding and emergency surgery could prevent severe complications.

Duodenojejunal intussusception secondary to primary gastrointestinal stromal tumor: A case report

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Gastrointestinal stromal tumor (GIST) in the third portion of the duodenum is rare.

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Intussusception and obstruction caused by GIST are uncommon.

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Adult intussusception usually requires surgical resection.

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If the location, tumor size, and resection margin of duodenal GIST are adequate for limited resection, it seems to be better than pancreaticoduodenectomy.

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Elderly patients can have improved quality of life with minimally invasive surgery.

Introduction

Gastrointestinal stromal tumors (GISTs) in the third portion of the duodenum are rare. Intussusception and obstruction are rarely caused by GISTs because of their tendency to grow in an extraluminal manner. Herein, we report a case involving segmental duodenectomy in a patient with duodenojejunal intussusception secondary to a primary GIST.

Presentation of case

A 91-year-old woman with a history of iron-deficiency anemia presented with vomiting and anorexia. Preoperative imaging suggested duodenojejunal intussusception secondary to a GIST in the third portion of the duodenum. Segmental duodenectomy with end-to-end duodenojejunostomy without reduction of the intussusception was performed. At 6 months after the surgery, the patient’s anemia had improved and she had no abdominal symptoms.

Discussion

Adult intussusception requires surgical resection because most of the patients have intraluminal lesions. The location in relation to the Vater papilla, tumor size, and resection margin should be considered when selecting the type of surgical resection for duodenal GIST. Limited resection appears to be better than pancreaticoduodenectomy with respect to postoperative complications. Considering the age and performance status of this patient, a less invasive maneuver was selected.

Conclusion

Duodenal GISTs can be a rare cause of intussusception. Thus, a limited surgical resection procedure should be considered in such cases.

A jejunal GIST presenting with obscure gastrointestinal bleeding and small bowel obstruction secondary to intussusception

A 68-year-old man with episodes of overt obscure gastrointestinal (GI) bleeding was investigated with multiple upper and lower GI endoscopies, CT enterography and capsule endoscopy, but no cause was found. He then presented acutely with small bowel obstruction. A laparotomy revealed complete small bowel obstruction secondary to jejunal intussusception over a 4 cm intraluminal polyp. Following resection and primary anastomosis, histology revealed that the polyp was a GI stromal tumour (GIST). This is an exceptionally uncommon presentation of a rare tumour. It is surprising that this tumour was not detected by CT enterography and not seen on capsule endoscopy. Immunohistochemistry and mutation analysis of the GIST suggested that it had a low risk of metastatic disease, but a high risk of recurrence. Staging CT scans did not reveal evidence of distal spread. The patient is currently receiving 3 years of chemotherapy with imatinib.

A rare case of jejuno-ileal intussusception secondary to a gastrointestinal stromal tumour

Gastrointestinal stromal tumours (GISTs) are rare tumours, making up 0.2-1% of gastrointestinal malignancies [Zakaria and Daradkeh (Jejunojejunal intussusception induced by a gastrointestinal stromal tumour. Case Rep Surg 2012; 2022: :173680)]. Their relative rarity combined with non-specific presentation results in tumours often remaining undiagnosed until surgery or histological examination [Martis et al. (A rare case of jejunojejunal intussusception in an adult. Indian J Surg 2013; 75: (Suppl 1):18-20)]. Presentation as a lead point for intussusception is particularly rare. We present the first case of GIST leading to intussusception at the jejuno-ileal junction in an otherwise well patient prior to presentation. Provisional diagnosis was made during emergency laparotomy, and confirmed through histological analysis. A typical immunohistochemical profile was identified, after which the patient was commenced on adjuvant imatinib therapy. We discuss classical presentation of intussusception and GIST. Further considerations of the investigation and treatment options of GISTs are also presented.

Laparoscopic-assisted resection of jejunojejunal intussusception caused by a juvenile polyp in an adult

Most bowel intussusceptions in adults have a leading point. However, there have been few reports of jejunojejunal intussusception secondary to a solitary juvenile polyp in adult. We report herein the case of a 19-year-old female with a solitary juvenile polyp in the jejunum causing intussusception. Laparoscopic-assisted reduction and segmental resection of the jejunum were successfully done for the patient.