Adult duodenal intussusception associated with congenital malrotation

Abstract

Enteroenteric intussusception is a condition in which full-thickness bowel wall becomes telescoped into the lumen of distal bowel. In adults, there is usually an abnormality acting as a lead point, usually a Meckels' diverticulum, a hamartoma or a tumour. Duodenoduodenal intussusception is exceptionally rare because the retroperitoneal situation fixes the duodenal wall. The aim of this report is to describe the first published case of this condition. A patient with duodeno-duodenal intussusception secondary to an ampullary lesion is reported. A 66 year-old lady presented with intermittent abdominal pain, weight loss and anaemia. Ultrasound scanning showed dilated bile and pancreatic ducts. CT scanning revealed intussusception involving the full-thickness duodenal wall. The lead point was an ampullary villous adenoma. Congenital partial (type Ⅱ) malrotation was found at operation and this abnormality permitted excessive mobility of the duodenal wall such that intussusception was possible. This condition can be diagnosed using enhanced CT. Intussusception can be complicated by bowel obstruction, ischaemia or bleeding, and therefore the underlying cause should be treated as soon as possible.

Intestinal malrotation associated with colon cancer in an adult: Report of a case

“…Gardner-Thorpe et al also reported a case of 66-year-old woman with congenital rotational abnormalities accompanied with a 9-cm ampullary villous adenoma. 22 The characteristics of the three cases of intestinal malrotation with malignancy are summarized in Table 2. Although there is no direct evidence for the relationship between a congenital abnormality and carcinogenesis, several studies may provide valuable clues to support the speculation that intestinal malrotation in adults is a possible underlying cause of pancreatitis and pancreatic tumors listed in Table 3.…”

“…Although there is no direct evidence for the relationship between a congenital abnormality and carcinogenesis, several studies may provide valuable clues to support the speculation that intestinal malrotation in adults is a possible underlying cause of pancreatitis and pancreatic tumors listed in Table 3. [21][22][23] Midgut volvulus in adults usually results in vascular compromise, and chronic intestinal ischemia and infl ammation. 14 Chronic infl ammation is one of factors associated with the formation of several malignant tumors.…”

Taking the Lead: A Case Report of a Leiomyoma Causing Duodeno-Duodenal Intussusception and Review of Literature

“…4 Intussusception of the proximal small bowel, especially with the intussusceptum and intussuscipiens isolated to the duodenum, is a rare condition with only 16 reported cases in the literature occurring in 19 total patients (Table 1). 1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17] Typically, the anatomic position of the duodenum in the retroperitoneal space and its fixed attachments in this region serve to prevent it from being susceptible to intussusception. However, this condition can occur due to a lead point such as a mass (90% of adults cases) 18 or secondary to congenital malrotation of the bowel, where the duodenum is more mobile, allowing the intussuception to occur.…”

“…Abdominal pain and distention, vomiting Tubulovillous adenoma Shakhnovich et al 16 14 Vomiting Duplication cyst Gardner-Thorpe et al 5 66…”

Duodenal intussusception due to a giant neuroendocrine carcinoma in a patient with Peutz–Jeghers syndrome

“…Note a large, lobulate, intraluminal mass as a lead point (star). The exact mechanism of duodenal intussusception is unknown; however, it is thought that any lesion in the duodenal wall or irritant within the lumen that alters normal peristaltic activity is able to initiate an invagination [1,10,15,19,22]. All patients reviewed were associated with a lead point (Table 1).…”