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Triple Intussusception in an Adult—A Rare Presentation of Adenocarcinoma IleumFunding None.
Intestinal intussusception is uncommon in adults. It occurs more often in the small intestine than in the colon. In adults, when small bowel intussusception occurs, it can be due to a malignant lead point. Malignant etiology is most frequently due to diffuse metastatic disease. We present a rare case of an 18-year-old woman who was diagnosed with jejunojejunal, jejunoileal, and colocolic intussusceptions. She presented with vomiting, abdominal pain, and passage of semisolid stools for 5 days. During emergency exploratory laparotomy, multiple polyps were found in the jejunum, ileum, and sigmoid. Jejunotomy and sigmoidotomy were done to remove the respective polyps. The ileal polyp showed hemorrhagic changes; hence, an intraoperative decision was taken to proceed with resection and anastomosis. On histopathological examination, the resected ileal part showed moderately differentiated adenocarcinoma (grade 2) arising from an adenomatous polyp, while the jejunal polyp and sigmoid polyp were adenomatous polyps with low-grade dysplasia. Patient received six cycles of adjuvant chemotherapy consisting of capecitabine and oxaliplatin (CAPEOX regimen). After 2 years, she is symptom free with a normal colonoscopy. The treatment of intussusception in adults typically involves surgery, often with bowel resection as there is always a pathologic leading cause which may be malignant, like in our case.
Informed consent was obtained from the participant.
Received: 27 May 2021
Accepted: 16 June 2021
05 October 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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- 1 Marinis A, Yiallourou A, Samanides L. et al. Intussusception of the bowel in adults: a review. World J Gastroenterol 2009; 15 (04) 407-411
- 2 Begos DG, Sandor A, Modlin IM. The diagnosis and management of adult intussusception. Am J Surg 1997; 173 (02) 88-94
- 3 Chamarthi M, Kejriwal GS, Sahu S. Simultaneous multiple intussusceptions in an adult patient caused by multifocal non-Hodgkin's lymphoma: the role of imaging. West Afr J Radiol 2012; 19: 19-22
- 4 Azar T, Berger DL. Adult intussusception. Ann Surg 1997; 226 (02) 134-138
- 5 Barussaud M, Regenet N, Briennon X. et al. Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Int J Colorectal Dis 2006; 21 (08) 834-839
- 6 Lu T, Chng YM. Adult intussusception. Perm J 2015; 19 (01) 79-81
- 7 Gupta M, Pal AK, Mukherjee R. A rare case of small bowel adenocarcinoma presenting as multiple intussusceptions: an unexpected diagnosis of intestinal obstruction. Int Surg J 2016; 3 (04) 2355-2357
- 8 Guo X, Mao Z, Su D, Jiang Z, Bai L. The clinical pathological features, diagnosis, treatment and prognosis of small intestine primary malignant tumors. Med Oncol 2014; 31 (04) 913
- 9 Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 2009; 249 (01) 63-71
- 10 Neugut AI, Marvin MR, Chabot JA. Adenocarcinoma of the small bowel. In: Holzheimer RG, Mannick JA. eds. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001
- 11 Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg 2017; 30 (01) 30-39
- 12 Stubenbord WT, Thorbjarnarson B. Intussusception in adults. Ann Surg 1970; 172 (02) 306-310
- 13 Yakan S, Caliskan C, Makay O, Denecli AG, Korkut MA. Intussusception in adults: clinical characteristics, diagnosis and operative strategies. World J Gastroenterol 2009; 15 (16) 1985-1989
- 14 Mrak K. Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception. J Gastrointest Oncol 2014; 5 (04) E75-E79
- 15 Wiersma F, Allema JH, Holscher HC. Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception. Pediatr Radiol 2006; 36 (11) 1177-1181
- 16 Lioubashevsky N, Hiller N, Rozovsky K, Segev L, Simanovsky N. Ileocolic versus small-bowel intussusception in children: can US enable reliable differentiation?. Radiology 2013; 269 (01) 266-271
- 17 Baleato-González S, Vilanova JC, García-Figueiras R, Juez IB, Martínez de Alegría A. Intussusception in adults: what radiologists should know. Emerg Radiol 2012; 19 (02) 89-101
- 18 Bauer RL, Palmer ML, Bauer AM, Nava HR, Douglass Jr HO. Adenocarcinoma of the small intestine: 21-year review of diagnosis, treatment, and prognosis. Ann Surg Oncol 1994; 1 (03) 183-188