|IMAGES AND VIDEOS
|Year : 2016 | Volume
| Issue : 5 | Page : 346-347
Small bowel intussusception induced by a jejunal gastrointestinal stromal cell tumor diagnosed by endoscopic ultrasound
Hussein Hassan Okasha1, Magdy Amin2, Reem Ezzat3, Mohamed El-Nady1, Ahmed Nagy4
1 Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
2 Department of Surgery, Maadi Military Hospital, Cairo, Egypt
3 Department of Internal Medicine and Gastroenterology, Assiut University, Assiut, Egypt
4 Department of Tropical Medicine, Cairo University, Cairo, Egypt
|Date of Submission||27-Sep-2015|
|Date of Acceptance||02-Mar-2016|
|Date of Web Publication||7-Oct-2016|
Hussein Hassan Okasha
Cairo University Cairo, Cairo
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Okasha HH, Amin M, Ezzat R, El-Nady M, Nagy A. Small bowel intussusception induced by a jejunal gastrointestinal stromal cell tumor diagnosed by endoscopic ultrasound. Endosc Ultrasound 2016;5:346-7
|How to cite this URL:|
Okasha HH, Amin M, Ezzat R, El-Nady M, Nagy A. Small bowel intussusception induced by a jejunal gastrointestinal stromal cell tumor diagnosed by endoscopic ultrasound. Endosc Ultrasound [serial online] 2016 [cited 2019 Dec 7];5:346-7. Available from: http://www.eusjournal.com/text.asp?2016/5/5/346/191683
A 48-year-old female was complaining of attacks of upper abdominal colicky lasting for about 2-6 h. The pain was recurring every 2-3 weeks for 2 months.
Abdominal computed tomography (CT) showed a solid mass with an area of cystic breakdown encroaching upon the body of the pancreas interpreted as a pancreatic lesion.
Upon EUS examination, an extraluminal bowel mass with typical doughnut appearance of intussusception was seen [Figure 1] and [Figure 2]. In another plane of examination, we noticed a bowel mass about 2 cm × 3 cm [Figure 3].
Surgical exploration was recommended and revealed jejunoduodenal intussusception with the presence of proximal jejunal mass [Figure 4] which proved to be a Gastrointestinal stromal tumor (GIST) upon histopathological examination.
| Discussion|| |
Bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of cases with bowel obstruction. GISTs are rare clinical entities, constituting <3% of all gastrointestinal malignant neoplasms and represent only 20% of small-bowel malignant neoplasms (excluding lymphoma). 
Intussusception is correctly diagnosed preoperatively in only one-third of cases.  In transverse section, ultrasound shows concentric rings of tissue representing components of the bowel wall and mesenteric fat referred to as the doughnut or target sign.
In our case, CT could see the bowel GIST as a mass encroaching upon the body of the pancreas, but the intussusception was not identified. Jejunal intussusception was diagnosed by EUS by the typical doughnut appearance.
After a review of the literature, we did not find any case of small-bowel intussusception diagnosed by EUS. There is one similar report, published in GIE in 2010 by Kularatna et al. and his group. They described a case of jejunal GIST properly diagnosed by EUS after being mistaken for a pancreatic mass on CT;  however, it was not associated with intussusception. To the best our knowledge, it is the first case of intussusception initiated by a jejunal GIST diagnosed during EUS examination.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Theodoropoulos GE, Linardoutsos D, Tsamis D, et al.
Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohn's disease. World J Gastroenterol
Badreldina R, Bowling T. Disorders of the small bowel. Surgery
Kularatna G, Azar RR, Mullady DK, et al
. Nearly missed GI stromal tumor: EUS diagnosis of a jejunal GI stromal tumor mistaken for a pancreatic mass on CT. Gastrointest Endosc
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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