Ileo-ileal intussusception due to inflammatory fibroid polyp: a rare cause of small bowel obstruction in adults

Abstract

Intussusception in adults is a relatively uncommon occurrence for a cause of bowel obstruction, which can present acutely, chronically or in an acute on chronic fashion. It is clinically concerning because of the possibility of cancer acting as a lead point. Small bowel tumours are rare, mostly detected incidentally with small bowel obstruction. Inflammatory fibroid polyp (IFP) is a rare benign tumour of the small bowel, either detected incidentally on imaging or endoscopy carried out for other reasons, or presents with acute features. We present a case of small bowel intussusception caused by IFP within the distal third of the ileum as a leading point. The patient presented acutely with small bowel obstruction, on a background of recurrent non-specific abdominal pain over the preceding month, and the computed tomography scan revealed an intussusception that was timely managed with a laparoscopy-assisted small bowel segmental resection.

Intussusception in an adult revealing a Vanek's tumor: A case report

“…The diagnosis is generally challenging. Laboratory tests and abdominal radiographs are not useful to suspect the diagnosis because lesions are found only in case of bowel obstruction with nonspecific features [8] , [9] . CT-scan is considered the most sensitive imaging in case of intussusception [10] .…”

Ileocolic Intussusception in an Adult Due to Inflammatory Fibroid Polyp: A Case Report

“…Small bowel lesions are not usually diagnosed pre-operatively because they present with vague symptoms of bowel obstruction due to intussusception. Laboratory investigations and abdominal radiographs are not helpful in making the diagnosis as they will demonstrate findings only in the presence of bowel obstruction [ 2 , 16 ].…”

“…Small IFPs often go undetected on radiology. But large IFPs can be easily detected on cross-sectional imaging but often resemble other gastrointestinal tumors such as gastrointestinal stromal tumors, neuroendocrine tumors, lymphoma, and adenocarcinoma [ 14 , 16 , 17 ]. Hence, preoperative diagnosis of small bowel IFP is difficult as seen in the present case.…”

“…Ileal IFP causing intussusception is rare and very few cases have been reported in literature [ 16 , 17 , 19 ]. Among the reported cases, IFPs less than 5 cm were missed while those larger than 5 cm were suspected to be gastrointestinal stromal tumors on preoperative CECT [ 16 , 17 ].…”

“…Ileal IFP causing intussusception is rare and very few cases have been reported in literature [ 16 , 17 , 19 ]. Among the reported cases, IFPs less than 5 cm were missed while those larger than 5 cm were suspected to be gastrointestinal stromal tumors on preoperative CECT [ 16 , 17 ]. All these patients underwent surgical excision similar to the present case and the diagnosis of IFP was confirmed on histopathology.…”