Acute Intestinal Obstruction Due to Ileocolic Intussusception in an Adult; A Rare Presentation of Inflammatory Myofibroblastic Tumor
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
Tariq Hameed, Mohak Singh, Adiba Nizam, Rahul Bhatia, Gaurish Sawant
Department of Surgery, Maulana Azad Medical College, New Delhi, India
Am J Case Rep 2020; 21:e920438
Available online: 2020-01-24
Intussusception is not very common in adults, and acute intestinal obstruction with intussusception due to inflammatory myofibroblastic tumor (IMT) is extremely rare. IMT is an uncommon lesion and has no single defined cause. It predominantly affects the pediatric age group and commonly involves the lungs. Here we present a case of IMT causing ileocolic intussusception leading to acute intestinal obstruction in an adult.
CASE REPORT: A 40-year-old female came to the emergency department with severe colicky pain in her abdomen, and reported 6 to 7 episodes of vomiting with bilious contents, along with an inability to pass feces and flatus for 3 days. An x-ray of her abdomen in erect posture revealed multiple air-fluid levels. Because she had a previous history of tuberculosis, a possible tubercular stricture as the cause of her acute obstruction was considered; an exploratory laparotomy was performed showing her bowel loops were dilated with ileocolic intussusception. The lead point of intussusception (a well-defined 4×4×3.5 cm solid mass), was found at 15 cm proximal to the ileocecal junction. A right hemicolectomy with ileo-transverse anastomosis was performed. The histopathological examination confirmed the presence of IMT.
CONCLUSIONS: IMT causing ileocolic intussusception with acute intestinal obstruction is an extremely rare presentation of an uncommon entity in adults. High index of suspicion, and appropriate investigations (x-ray abdomen, ultrasound, computed tomography, and colonoscopy) depending on presentation and clinical condition of the patient can result in prompt diagnosis and early management.
Keywords: Intestinal Obstruction, Intussusception, Neoplasms, Muscle Tissue