Intussusception of the Jejunum Due to Carcinoid Tumor

Abstract

ABOUT 75 per cent of the cases of intussusception occur in children under two years of age,1 although a specific cause for the production of the invagination in children is usually not found. Perrin and Lindsay2 found only 18 patients over fourteen years of age in a series of 314 cases collected at the London Hospital from 1903 to 1920.In adult cases of intussusception, a tumor is the commonest etiologic agent. Eliot and Corscaden,3 in their analysis of 300 cases of intussusception in adults, found a tumor of the bowel in 40 per cent of the cases, of which the greater number were benign. Other causes were ulcération of the bowel of tuberculous, bacillary or typhoid origin in 14 per cent, and a Meckel's diverticulum in 12 per cent. Among the tumors usually found were polyps, leiomyomas, lipomas, fibromas and carcinomas.Tumors of the small intestine are relatively infrequent as compared with tumors of the other parts of the gastrointestinal tract. Raiford1 in 1932, in a very full discussion of tumors of the small intestine, reported a series of 88 cases found among 11,500 autopsies and 45,000 surgical specimens at the Johns Hopkins Hospital. He was also able to collect from the literature 339 tumors of the small intestine that he considered authentic. The 88 cases comprised 8.9 per cent of the total number of gastrointestinal tumors, which was 986. The 50 benign and 38 malignant small intestinal tumors comprised 23.8 per cent and 4.9 per cent respectively of the total benign tumors (210) and total malignant tumors (776) of the gastrointestinal tract. The benign tumors included adenomas, fibromas, myomas, lipomas, angiomas, pancreatic rests, hemangiomas, argentaffin (carcinoid) tumors and cysts. In this series the carcinoid or argentaffin tumors numbered 7, and were all benign.Tumors of the small intestine often produce no symptoms, and are found only incidentally at autopsy. The symptoms that they do produce are usually the result of obstruction of the intestine, incomplete or complete, or of the production of an intussusception.Freilich and Coe5 were able to collect from the literature a total of 3284 cases of intussusception, of which 462 were enteric; and of these, 24 were jejunal. Altogether, from 1852 to 1934, 29 recorded cases of jejunal intussusception occurred in patients from four months to sixty-seven years old, with an average age of 27; 15 cases were in men, 13 in women, and 1 not specified; 18 were of a simple jejunojejunal type, 9 were double jejunal, and 2 were triple jejunal. The majority were caused by such tumors as polyps, lipomas and papillary adenomas. No case of jejunal intussusception due to a carcinoid tumor was listed.No specific character of the carcinoid tumor, as compared with other tumors, makes it less likely to produce an intussusception. The relative rarity of carcinoid tumors probably accounts for the paucity of such occurrences. In 1930, Cooke" collected from the literature 104 cases of carcinoid tumor of the small intestine, and added 11 of his own. Ariel,7 in the most recent revi...