Endoscopic Ultrasound

IMAGES AND VIDEOS
Year
: 2016  |  Volume : 5  |  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

Correspondence Address:
Hussein Hassan Okasha
Cairo University Cairo, Cairo
Egypt




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;5:346-347


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 11 ];5:346-347
Available from: http://www.eusjournal.com/text.asp?2016/5/5/346/191683


Full Text

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].{Figure 1}{Figure 2}{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.{Figure 4}

 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). [1]

Intussusception is correctly diagnosed preoperatively in only one-third of cases. [2] 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; [3] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Theodoropoulos GE, Linardoutsos D, Tsamis D, et al. Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohn's disease. World J Gastroenterol 2009;15:5224-7.
2Badreldina R, Bowling T. Disorders of the small bowel. Surgery 2008;26:338-42.
3Kularatna 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 2010;71:1065-6.