Jejunojejunal intussusception secondary to adenocarcinoma

Abstract

s e F o s t 75-year-old woman was admitted with a 5-day history of bdominal pain associated with vomiting and absent defeation. Three months before, a barium enema study had hown diverticulosis coli, but no signs of tumor or stenosis. he had a body temperature of 38.3°C, a blood pressure of 00/70 mm Hg, and a pulse of 100 beats per minute. hysical examination revealed abdominal distension, hypoctive bowel sounds, and mild tenderness predominantly on he right side, but there were no peritoneal signs. Initial aboratory tests showed a white blood cell count of 19,700 ells per /L (normal levels 4.0 to 10.0), C-reactive protein f 13 mg/L ( 10), serum urea of 23.6 mmol/L (2.5 to 6.7), erum creatinin of 486 mol/L (55 to 90), and slightly levated liver function tests. Plain radiography of chest and bdomen, as well as ultrasonography of the kidneys, howed no abnormalities. In particular, no marked signs of owel obstruction were noted. At that stage, diverticulitis nd dehydration with prerenal insufficiency were considred, and conservative treatment was initiated. For the next 7 days, the clinical picture alternately imroved and worsened. On the seventh day after admission, epeat radiography of the abdomen was normal, although linically the abdomen remained distended. Subsequently, omputed tomography scanning revealed dilation of duodeum and proximal part of the jejunum, and part of the ejunum was intussuscepted (Fig. 1A). The cause of the ntussusception was seen on the ventral left part of the ejunum, namely, a tumorous process (Fig. 1B). At laparotmy, a large 30-cm jejunal intussusception was recognized. anual reduction was performed, after which the cause, a mall tumor, became obvious. A segment extending 5 cm oth proximal and distal to the tumor was resected with rimary end-to-end anastomosis. Histologic examination