Role of enteroscopy in the diagnosis and management of adult small-bowel intussusception.

Abstract

A 77-year-old man presented with abdominal discomfort, nonbloody emesis, melena, and syncope. His hemoglobin count was 6.2 g/dL. A CT of his abdomen showed a proximal jejunojejunal intussusception with a 2.4 cm × 2.7 cm intraluminal enhancing mass as the lead point (Fig. 1). Endoscopic evaluation was initially performed by use of antegrade double-balloon endoscopy (EN-450T5, Fujinon, Inc; Wayne, NJ). At 80 cm in the proximal jejunum, a jejunojejunal intussusception was found, causing near complete obstruction. The obstructed area was traversable, and the endoscope was advanced downstream. Reduction of the intussusception was achieved by keeping only the balloon of the endoscope inflated during withdrawal. A 3-cm submucosal round mass with no active bleeding was found at the area of intussusception. A cap-fitted colonoscope (EC-3490TLi, Pentax; Montvale, NJ) was then used for enteroscopy to manipulate and deflect the folds for better visualization. Tunneled biopsy specimens of the mass were obtained for early preoperative pathologic diagnosis with subsequent endoclip placement. A tattoo was placed proximal and distal to the mass (Video 1, available online at www.giejournal.org). Tunneled biopsy results showed a spindle cell lesion, consistent with gastrointestinal stromal tumor (GIST). Surgical removal through laparoscopic small-bowel resection with primary anastomosis was then performed. The final pathologic examination showed a GIST: positive for c-kit (CD 117), Ki-67 of 2%, and mitotic rate 1 to 2 per 50 high-power field.