A very rare case of a small bowel leiomyosarcoma leading to ileocaecal intussusception treated with a laparoscopic resection: a case report and a literature review

Abstract

BackgroundSmall bowel tumours are rare and comprise less than 2 % of all primary gastrointestinal neoplasms. Among these tumours, a leiomyosarcoma belonging to soft tissue sarcomas is extremely rare and accounts for about 1 % of malignant mesenchymal lesions in the gastrointestinal tract. Due to its aggressive nature and slow growth, it is often diagnosed at the late stage when curative treatment is impossible. Authors report a first case of leiomyosarcoma with chronic recurrent ileocaecal intussusception and literature review to analyse diagnosis and treatment features of the ileum mesenchymal tumours.Case presentationWe present a case of an 87-year-old Caucasian man suffering from cramp-like abdominal pain for months. Due to lack of clinical signs and unspecific complaints, a diagnosis was delayed. Despite a detailed in-hospital examination, a proper diagnosis was established as late as during an operation. The patient was treated by surgery with good results. An uncommon laparoscopic resection of the small bowel with a tumour was performed. A histopathological investigation confirmed a very rare mesenchymal lesion of the distal ileum. The patient is under control with no recurrence for 1 year of the follow-up period.ConclusionsReported case indicates that a usually asymptomatic tumour can cause uncommon chronic recurrent ileus signs. CT and MRI scans are investigation of choice in such cases, but they are sometimes inconclusive. It might be worth highlighting the good results of laparoscopic leiomyosarcoma lesion resection with a very good outcome.

An Unusual Small Bowel Lesion

“…It appears most commonly in the retroperitoneum, large blood vessels, and uterus, and less frequently in the lower extremities [1, 2]. Both primary and metastatic leiomyosarcoma of the small bowel are extremely rare [3]. In our case, the primary tumor is unknown since the diagnosis was made at a late stage of the disease, although clinical history strongly suggests that the lower limb might have been the origin.…”

“…However, surgery was not considered since she had disseminated disease and bowel obstruction relieved with conservative measures. In fact, intussusception often reduces spontaneously, although it can recur [3]. Small bowel metastasis by leiomyosarcoma is usually a sign of extensive disease and carries an unfavorable prognosis.…”

Ileocolonic intussusception caused by epithelioid leiomyosarcoma of the ileum: a report of case and review of the literature

“…Small intestinal malignant tumors are rare and comprise less than 3% of all primary GI neoplasms [ 4 ]. There are several conditions that increase the risk of development of small intestinal malignancies, including inflammatory bowel diseases such as Crohn disease, polyposis syndrome, and hereditary nonpolyposis colorectal cancer [ 7 ].…”

Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors

“…[ 32 ] Some studies have evaluated laparoscopic surgery for patients with intussusception under general conditions and have found that laparoscopic surgery is a safe and effective surgical method. [ 10 , 33 ] Laparoscopic surgery helps with accurate identification of the position and causes of the intussusception and is associated with minimal trauma and a quick recovery. In this report, 2 patients underwent laparoscopic intussusception reduction and ileal tumor resection.…”