SMALL BOWEL INTUSSUSCEPTION CAUSED BY METASTASIS FROM A LOWER LIMB LIPOSARCOMA

Introduction

Liposarcoma represents one of the most frequent types of soft tissue sarcomas, constituting a heterogeneous group of lesions. There are four different subtypes: well-differentiated; dedifferentiated; myxoid and pleomorphic. Its main locations are the retroperitoneum, extremities, trunk and the cervical area.

Clinical case

A 90-year-old male with a pleomorphic liposarcoma in the left thigh in 2012, local recurrence from a dedifferentiated liposarcoma in 2018 and 2021, presented to our emergency department with abdominal pain and vomiting. CT scan revealed an image of intestinal intussusception in the distal jejunum due to a 5 cm intraluminal polyp.

Emergency laparotomy revealed a change in the distal jejunum caliber caused by the intussusception finding a 5 cm polypoid mass. We made an intestinal resection with a L-L anastomosis. Histopathological examination showed evidence of metastasis from dedifferentiated liposarcoma.

Discussion

A sarcoma is a malignant tumor, an infrequent type of cancer from connective tissue. The liposarcoma is the most frequent subtype and the dedifferentiated type can occur as dedifferentiation from other subtypes. The most common sites of metastasis include the lung, liver, and bone. Metastasis to the small bowel is rare with few reported cases.

Intestinal intussusception is an infrequent cause of mechanical intestinal obstruction in adults. Etiology is diverse and it is often caused by benign lesions in the small bowel and malignant lesions in the colon. The diagnostic technique of choice is the CT scan with contrast and treatment usually requires surgery. Intestinal reduction is controversial because of the risk of perforation or tumor spread.