Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors

Abstract

Rationale:Adult intussusception is rarely observed, and the clinical manifestations are very atypical. The most common symptom is abdominal pain, while the incidence of hematochezia is relatively low. We report two cases of adult intussusception secondary to small intestinal tumors with gastrointestinal hemorrhage as the main symptom.Patient concerns:Two men aged 19 and 54 years were successively referred to our department due to intermittent hematochezia. The hemoglobin levels of the two patients declined progressively, and conservative treatment was ineffective.Diagnoses:The first patient underwent an abdominal computed tomography angiography examination, which showed that the intestine and its mesentery were tortuous, suggesting an intra-abdominal hernia or intussusception. The second patient underwent an abdominal computed tomography examination, which suggested a high possibility of an intussusception. The two patients were diagnosed as adult intussusception caused by small intestinal tumors.Interventions:Emergency laparoscopic explorations were performed. Enteroenteric intussusceptions caused by ileal tumors were found during surgery. Reduction of the intussusceptions and resection of the ileal tumors were performed.Outcomes:The patients recovered well after surgery, and postoperative pathology showed that the tumors were a vascular hamartoma polyp and a lipoma.Lessons:Adult intussusception is very rare, particularly with gastrointestinal hemorrhage as the main symptom. Isolated hamartoma polyp is a rare cause of intussusception in adults. The clinical manifestations of adult intussusception are very atypical, and thus, making a preoperative diagnosis is difficult. Abdominal CT or CTA is an effective diagnostic method for adult intussusception. For adult patients with gastrointestinal hemorrhage caused by intussusceptions, active surgery should be performed when conservative treatment is not effective. Laparoscopic surgery is a safe and effective treatment for adult intussusceptions caused by benign diseases.

Intussusception Presenting as Intestinal Obstruction in Pregnancy: A Case Report from a Tertiary Hospital in Ghana

“…The treatment of choice among adults is surgical resection [11,13,16,19,20,21,22,26,28,29]. This is because it is associated with a lead point in 90% of cases, 65% of which are malignant [10,17].…”

“…The use of radiological imaging (ultrasonography and Magnetic Resonance Imaging) in confirming diagnosis of intussusception in pregnancy cannot be overemphasized [8,11,13,14]. The treatment of choice for intussusception in adults is surgical resection, unlike in children where a more conservative approach is favored [11,13,16,19,20,21,22,26,28,29].…”

Multidetector computed tomography diagnosis of small bowel intussusceptions in adults: observations in a 10-year single-center study

“…Most intussusceptions in adults are chronic and characterized by incomplete intestinal obstruction. Clinical symptoms can include abdominal pain, nausea, vomiting, abdominal distension, and blood in the stool (2)(3)(4)8).…”

“…Intussusception is relatively rare in adults, only accounting for an estimated 5% of all intussusceptions and 1% of the causes of intestinal obstruction, and its causes are varied (1)(2)(3)(4). Previous studies based on discharge diagnoses and surgical results suggest that 80%-90% of adult intussusceptions have an underlying cause, approximately 65% are due to malignant neoplasm, and the colon is involved in intussusceptions more often than the small bowel (2).…”

Invaginación Intestinal

“…(8,9) También pueden estar presentes otras lesiones anatómicas como son el divertículo de Meckel, los linfomas del intestino, los pólipos, las duplicidades digestivas, los hematomas submucosos en pacientes portadores de púrpura de Schönlein-Henoch o enfermedades hematológicas que causen sangrados y hematomas, así como malformaciones vasculares tales como el hemangioma, contenido intestinal muy espeso o viscoso en pacientes con fibrosis quística u otra enfermedad de origen genético. (10) El tejido pancreático heterotópico puede ocasionar invaginación intestinal; de igual manera, algunos casos en los que se haya practicado apendicectomía con inversión del muñón apendicular, y pacientes con parasitismo intestinal en los que el paquete de áscaris lumbricoides puede actuar como cabeza invaginante. (11,12)…”