Inflammatory fibroid polyp (Vanek&apos;s tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report

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Abstract

Introduction and importance

The majority of the of small bowel intussusception causes are benign, and different types of benign tumors have been reported as the lead points of an intussusception. Among these, some studies have reported inflammatory fibroid polyp as a cause of small bowel intussusception. However, according to our knowledge this is the first case to be reported in Africa of an adult double compound intussusception due to an inflammatory fibroid polyp.

Case report

A 32-year-old female presented with epigastric abdominal pain, nausea, vomiting and diarrhea for 2 weeks. Investigations revealed a small bowel obstruction due to intussusception, and exploratory laparotomy was planned.

Clinical discussion

Inflammatory fibroid polyp causing this unique feature of double compound ileo-ileal intussusception should be observed in adult patients who presents with intestinal obstruction. A CT scan is the diagnostic modality of choice, and we think that the disease is the first of its kind to be reported in Africa.

Conclusions

Double ileo-ileal intussusception is a rare cause of intestinal obstruction in adult patients.

Interventions and outcome

Laparotomy reviled an ileo-ileal intussusception. After manual reduction of this intussusception, another intussusception was observed and containing a polyp. A clear margin resection and end-to-end primary anastomosis were performed. The histopathological report established the diagnosis of Inflammatory Fibroid Polyp. After the procedure, the patient's condition improved well with no complications.

Methods

This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [1]).

Highlights

•

Intussusception is a condition in which there is telescoping ladder f one bowel segment into another resulting in mechanical bowel obstruction.
•

While intussusception is considered a common condition in infants and young children, it is rare in adults. It is not common to have two lead points (Double intussusception) for the disease, causing symptoms simultaneously.
•

In this case, we report a case of double intussusception in an adult patient, something that has been reported in only handful of cases worldwide.

Related collections

Most cited references 17

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The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines

Riaz Agha, Thomas Franchi, Catrin Sohrabi … (2020)

The SCARE Guidelines were first published in 2016 and were last updated in 2018. They provide a structure for reporting surgical case reports and are used and endorsed by authors, journal editors and reviewers, in order to increase robustness and transparency in reporting surgical cases. They must be kept up to date in order to drive forwards reporting quality. As such, we have updated these guidelines via a DELPHI consensus exercise.

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The diagnosis and management of adult intussusception.

D G Begos, A Sandor, I M Modlin (1997)

While intussusception is relatively common in children, it is a rare clinical entity in adults, where the condition is almost always secondary to a definable lesion. Thirteen cases of intussusception occurring in individuals older than 16 were encountered at our institute between 1981 and 1994. Presenting signs/symptoms included recurrent bowel obstruction, intermittent pain, and red blood per rectum. Correct preoperative diagnosis was made in six patients using colonoscopy, flexible sigmoidoscopy, upper gastrointestinal (GI) series and computed tomography (CT). At surgery the lead point was identified in the small intestine in eight cases, in the colon in four cases, and one small intestinal intussusception was considered idiopathic. Twelve patients underwent laparotomy and one patient was both diagnosed and treated by colonoscopy alone. Adult intussusception is an unusual cause of bowel obstruction. The likelihood of neoplasia, particularly in the colon as a cause, is high. Operative management is thus almost always necessary.

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Intussusception in adults: institutional review.

A. H. Aufses, Thomas D. Cunningham, Jane L Eisen (1999)

Intestinal intussusception in the adult is a rare entity that differs greatly in etiology from its pediatric counterpart. Controversy remains regarding the optimal management of this problem in the adult patient. The purpose of this study was to determine the cause(s) of intussusception and to determine the role of intestinal reduction in the management of intussusception in adults. A retrospective review performed at The Mount Sinai Medical Center identified 27 patients, 16 years and older, with a diagnosis of intestinal intussusception. Data related to presentation, diagnosis, treatment, and pathology were analyzed. There were 13 males and 14 females. The median age of the group was 52 years with a range of 16 to 90 years. Abdominal pain was the most common presenting complaint. A preoperative diagnosis was suspected in 11 of 27 patients (40%). There were 22 small bowel lesions and 5 colonic lesions. A pathologic cause was identified in 85% of patients with 8 of 22 (36%) small bowel and 4 of 5 (80%) of large bowel lesions being malignant. All small bowel cancers represented metastatic disease and all large bowel malignancies were primary adenocarcinomas. The median age of patients with malignant disease was 60 years; it was 44 years for those with benign disease. Operative treatment consisted of resection alone in 58% of patients and resection after reduction in 42%. Three patients were treated nonoperatively. Our data support a selective approach to the operative treatment of intussusception in adults. Colonic lesions should not be reduced before resection because they most likely represent a primary adenocarcinoma. Small bowel intussusception should be reduced only in patients in whom a benign diagnosis has been made preoperatively or in patients in whom resection may result in short gut syndrome.

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Author and article information

Contributors

Ahmed Gadoura

Farah Mohammed

Journal

Journal ID (nlm-ta): Int J Surg Case Rep

Journal ID (iso-abbrev): Int J Surg Case Rep

Title: International Journal of Surgery Case Reports

Publisher: Elsevier

ISSN (Electronic): 2210-2612

Publication date PMC-release: 16 March 2022

Publication date Collection: April 2022

Publication date (Electronic): 16 March 2022

Volume: 93

Electronic Location Identifier: 106947

Affiliations

[a ]Alzaiem Alazhari University, Department of Surgery, Sudan

[b ]National Ribat University, Sudan

Author notes

[* ]Corresponding authors. Ahmedmohammedali1995@ 123456gmail.com zezu2009@ 123456gmail.com

Article

Publisher Item ID: S2210-2612(22)00193-6 Publisher ID: 106947

DOI: 10.1016/j.ijscr.2022.106947

PMC ID: 8935495

SO-VID: f50ce175-b8c8-4a01-a166-5e0ead3483f6

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 31 January 2022

Date revision received : 11 March 2022

Date accepted : 13 March 2022

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