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Ileoileal intussusception as initial manifestation of Crohn’s disease

López-Tomassetti Fernández EM, Lorenzo Rocha N, Arteaga González I, Carrillo Pallarés A - Mcgill J Med (2006)

Bottom Line: Resection without prior reduction has been the traditional treatment of choice due to the significant risk for malignancy found in most series.A long intestinal resection was necessary and the patient was discharged without major complications.The practical benefit for reduction of viable bowel in Crohn's patients is the preservation of bowel length.

Affiliation: Department of Gastrointestinal Surgery, Hospital Universitario de Canarias (HUC), Canary Islands, Spain. drtomassetti@wanadoo.es

ABSTRACT

Intussusception is usually considered a childhood condition, but it may also be present in adults, where it is more often associated with an underlying pathology. There is no agreement upon the correct treatment of adult intussusception, although surgical intervention is considered necessary. Resection without prior reduction has been the traditional treatment of choice due to the significant risk for malignancy found in most series. We describe an unusual case of intestinal necrosis secondary to ileoileal intussusception caused by Crohn's disease. A long intestinal resection was necessary and the patient was discharged without major complications. Based on the details of this case, the authors emphasize the potential importance of considering individualized treatment of adult intussusception. The practical benefit for reduction of viable bowel in Crohn's patients is the preservation of bowel length.

Microscopy examination of the specimen (H&E, 100x):A. Thickening of muscularis mucosae with granulomas occurs near the obstructive point.B. Granulomas were present in the mucosa.
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f4-mjm9_1p34: Microscopy examination of the specimen (H&E, 100x):A. Thickening of muscularis mucosae with granulomas occurs near the obstructive point.B. Granulomas were present in the mucosa.

Mentions: Microscopy revealed extensive infarcted hemorrhage. Peripherally, a 10 cm-long bowel without necrosis was further studied. It showed pathological changes similar to Crohn’s disease. The mucosa was infiltrated with neutrophils. Transmural inflammation, deep ulcerations, and non-necrotizing epithelioid cell granuloma (sarcoid like-granulomas) were demonstrated (Figure 4). Resected lymph nodes displayed granulomas with fibrotic changes. A final diagnosis of inflammatory Crohn’s disease affecting the ileum was made.

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Ileoileal intussusception as initial manifestation of Crohn’s disease

López-Tomassetti Fernández EM, Lorenzo Rocha N, Arteaga González I, Carrillo Pallarés A - Mcgill J Med (2006)

Microscopy examination of the specimen (H&E, 100x):A. Thickening of muscularis mucosae with granulomas occurs near the obstructive point.B. Granulomas were present in the mucosa.
© Copyright Policy
f4-mjm9_1p34: Microscopy examination of the specimen (H&E, 100x):A. Thickening of muscularis mucosae with granulomas occurs near the obstructive point.B. Granulomas were present in the mucosa.
Mentions: Microscopy revealed extensive infarcted hemorrhage. Peripherally, a 10 cm-long bowel without necrosis was further studied. It showed pathological changes similar to Crohn’s disease. The mucosa was infiltrated with neutrophils. Transmural inflammation, deep ulcerations, and non-necrotizing epithelioid cell granuloma (sarcoid like-granulomas) were demonstrated (Figure 4). Resected lymph nodes displayed granulomas with fibrotic changes. A final diagnosis of inflammatory Crohn’s disease affecting the ileum was made.

Bottom Line: Resection without prior reduction has been the traditional treatment of choice due to the significant risk for malignancy found in most series.A long intestinal resection was necessary and the patient was discharged without major complications.The practical benefit for reduction of viable bowel in Crohn's patients is the preservation of bowel length.

Affiliation: Department of Gastrointestinal Surgery, Hospital Universitario de Canarias (HUC), Canary Islands, Spain. drtomassetti@wanadoo.es

ABSTRACT

Intussusception is usually considered a childhood condition, but it may also be present in adults, where it is more often associated with an underlying pathology. There is no agreement upon the correct treatment of adult intussusception, although surgical intervention is considered necessary. Resection without prior reduction has been the traditional treatment of choice due to the significant risk for malignancy found in most series. We describe an unusual case of intestinal necrosis secondary to ileoileal intussusception caused by Crohn's disease. A long intestinal resection was necessary and the patient was discharged without major complications. Based on the details of this case, the authors emphasize the potential importance of considering individualized treatment of adult intussusception. The practical benefit for reduction of viable bowel in Crohn's patients is the preservation of bowel length.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2687895&rFormat=json&query=null&req=5