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Triple jejuno-jejunal intussusception due to metastatic renal cell carcinoma.

Massy Budmiger AS, Nagy V, Hürlimann S, Metzger J - J Surg Case Rep (2015)

Bottom Line: Intra-operative findings were five intramural masses 15 cm distal to the ligament of Treitz over a total length of 50 cm.A primary en bloc resection with an end-to-end anastomosis was carried out.The postoperative course was uneventful.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Visceral Surgery, Hospital of Lucerne, Lucerne, Switzerland anne-sophie.massybudmiger@luks.ch.

No MeSH data available.


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CT scan revealing enhanced masses and jejunal invagination (target sign).
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RJV047F1: CT scan revealing enhanced masses and jejunal invagination (target sign).

Mentions: A 61-year-old man with metastatic clear-cell RCC diagnosed 3 years previously presented to the local accident and emergency department (A&E) because of abdominal pain and vomiting. After tumour nephrectomy, he received sequential treatment with sunitinib, everolimus, axitinib and sorafenib for lymph node and lung metastases. Sorafenib was stopped 1 month before admission, when the patient developed dyspnoea as a result of severe normochromic/normocytic anaemia and compression of the right main bronchus by a right hilar, lymph node metastasis. At that time, CT showed no other sites of progressive disease. As the patient reported intermittent melaena, oesophago-gastroduodenoscopy and colonoscopy were performed. No evidence of tumour or bleeding was evident. Thus, anaemia was attributed to progressive carcinoma and sorafenib treatment. Over the course of 4 weeks, the patient was treated with palliative radiotherapy to the right pulmonary hilum and received frequent erythrocyte transfusions for refractory anaemia. At presentation to A&E, he had had recurrent abdominal pain and emesis for 1 week. The physical examination was unremarkable. An abdominal CT scan revealed small bowel obstruction and triple jejuno-jejunal intussusception with the typical ‘target sign’, as well as several apparently intra-luminal tumour masses (Fig. 1), which had not been evident on the CT scan 6 weeks earlier. No tumour progression in other metastatic sites was detected.Figure 1:


Triple jejuno-jejunal intussusception due to metastatic renal cell carcinoma.

Massy Budmiger AS, Nagy V, Hürlimann S, Metzger J - J Surg Case Rep (2015)

CT scan revealing enhanced masses and jejunal invagination (target sign).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400532&req=5

RJV047F1: CT scan revealing enhanced masses and jejunal invagination (target sign).
Mentions: A 61-year-old man with metastatic clear-cell RCC diagnosed 3 years previously presented to the local accident and emergency department (A&E) because of abdominal pain and vomiting. After tumour nephrectomy, he received sequential treatment with sunitinib, everolimus, axitinib and sorafenib for lymph node and lung metastases. Sorafenib was stopped 1 month before admission, when the patient developed dyspnoea as a result of severe normochromic/normocytic anaemia and compression of the right main bronchus by a right hilar, lymph node metastasis. At that time, CT showed no other sites of progressive disease. As the patient reported intermittent melaena, oesophago-gastroduodenoscopy and colonoscopy were performed. No evidence of tumour or bleeding was evident. Thus, anaemia was attributed to progressive carcinoma and sorafenib treatment. Over the course of 4 weeks, the patient was treated with palliative radiotherapy to the right pulmonary hilum and received frequent erythrocyte transfusions for refractory anaemia. At presentation to A&E, he had had recurrent abdominal pain and emesis for 1 week. The physical examination was unremarkable. An abdominal CT scan revealed small bowel obstruction and triple jejuno-jejunal intussusception with the typical ‘target sign’, as well as several apparently intra-luminal tumour masses (Fig. 1), which had not been evident on the CT scan 6 weeks earlier. No tumour progression in other metastatic sites was detected.Figure 1:

Bottom Line: Intra-operative findings were five intramural masses 15 cm distal to the ligament of Treitz over a total length of 50 cm.A primary en bloc resection with an end-to-end anastomosis was carried out.The postoperative course was uneventful.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Visceral Surgery, Hospital of Lucerne, Lucerne, Switzerland anne-sophie.massybudmiger@luks.ch.

No MeSH data available.


Related in: MedlinePlus