Case Presentation:
A 44‐year‐old male patient was admitted for recurrent progressively worsening colicky abdominal pain and bleeding per rectum of about 2 months’ duration. There was also an episode of lightheadedness and clear vomiting on the morning of admission. On examination, his abdomen revealed tenderness in the left iliac fossa with no rebound tenderness or palpable masses. Rectal exam was unremarkable except for positive fecal occult blood on subsequent testing. His workup showed hemoglobin 7.4 g/dL, white blood cell count 13.4 × 103/μL with normal differential. Malignancy and inflammatory bowel diseases were suspected. Abdominal x‐rays showed dilated small bowel loops and multiple air–fluid levels, consistent with mechanical ileus. Abdominal CT revealed ileocolic intussusception. The patient was then taken to the operating room, where a right hemicolectomy and extended ileac resection were performed. Surgery revealed a thickened mass involving the terminal ileum and a cecal mass responsible for the ileo‐colic intussusception. Histopathology of the mass showed a diffuse large B‐cell lymphoma of the terminal ileum. No systemic lymphadenopathy was found, suggesting a primary gastrointestinal non‐Hodgkin's lymphoma. HIV test was negative. The patient's postoperative course was uneventful, and on discharge home, he was instructed to follow up at the oncology clinic.
A computed tomography scan of the abdomen reveals the terminal ileum as a “target” lesion (black arrow) prolapsed in the cecum, suggesting an ileocecal intussusception.
Gross specimen of the right hemicolectomy. On opening the lumen of the terminal ileum, it demonstrated intussusception of the terminal ileum into the cecum because of a diffuse, thickened tumor mass involving the wall of the terminal ileum. The mass was causing narrowing of the lumen. A, lumen of the terminal ileum; B, tumor mass.
Discussion:
Protrusion of a bowel segment into another (intussusception) may produce severe abdominal pain and culminate in intestinal obstruction. In adults, intestinal obstruction because of intussusception is a relatively rare phenomenon, as it accounts for 1% of all cases of intestinal obstructions in this population demographic. In contrast to the pediatric population, where intussusception is usually idiopathic or secondary to viral illness, an organic lesion is usually identifiable as the cause of adult intussusceptions; neoplasms account for the majority. Surgical resection without reduction is almost always necessary in adult intussusception, given the high percentage of associated malignancy. Here, we describe a rare case of a 53‐year‐old man with mucosa‐associated lymphoid tissue (MALT) B‐cell lymphoma in the terminal ileum that had caused ileocolic intussusception and resulted in intestinal obstruction and required surgical resection.
Conclusions:
This case is unique in that intussusception is a relatively rare phenomenon in the adult population. One should entertain a high degree of suspicion for malignancy when presented with intussusception in an adult, despite HIV‐neg‐ative status. Lastly, surgery is the treatment of choice.
Disclosures:
K. Shaheen ‐ none; D. Frackowiak ‐ none; S. Merugu ‐ none