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Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report.

Saka R, Sasaki T, Matsuda I, Nose S, Onishi M, Fujino T, Shimomura H, Otsuka Y, Kajimoto N, Hirota S, Oue T - Springerplus (2015)

Bottom Line: The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg.Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery.Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501 Japan.

ABSTRACT
Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient's abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient's postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming 'chronic' intussusception in older children.

No MeSH data available.


Related in: MedlinePlus

Preoperative images. a Ultrasonography showed the “target sign” in the lower abdomen. b Enhanced CT revealed ileocolic intussusception and stretched mesenteric vessels. c The outer wall of the area of intussusception consisted of an edematous ileum (inner layer; black arrow) and dilated colon (outer layer; white arrow). d An enema examination showed “crab’s claw sign” in the transverse colon.
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Fig1: Preoperative images. a Ultrasonography showed the “target sign” in the lower abdomen. b Enhanced CT revealed ileocolic intussusception and stretched mesenteric vessels. c The outer wall of the area of intussusception consisted of an edematous ileum (inner layer; black arrow) and dilated colon (outer layer; white arrow). d An enema examination showed “crab’s claw sign” in the transverse colon.

Mentions: An ultrasonography examination of the abdomen showed a target sign at the lower abdomen, indicating the existence of intussusception (Figure 1). Enhanced computed tomography (CT) also revealed ileocolic intussusception with a suspicious looking mass (Figure 1). In addition, an examination of abdominal CT performed at the previous clinic 5 weeks earlier made us suspicious of signs of ileocolic intussusception (Figure 2). Therefore, the initial appearance of the intussusception coincided with the beginning of his symptoms 5 weeks previously. We concluded that his symptoms were due to chronic intussusception, with an organic lead point. An attempt at hydrostatic reduction with gastrografin® (Bayer Yakuhin, Osaka, Japan) was not successful (Figure 1); therefore, an emergent operation was conducted.Figure 1


Chronic ileocolic intussusception due to transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy: a case report.

Saka R, Sasaki T, Matsuda I, Nose S, Onishi M, Fujino T, Shimomura H, Otsuka Y, Kajimoto N, Hirota S, Oue T - Springerplus (2015)

Preoperative images. a Ultrasonography showed the “target sign” in the lower abdomen. b Enhanced CT revealed ileocolic intussusception and stretched mesenteric vessels. c The outer wall of the area of intussusception consisted of an edematous ileum (inner layer; black arrow) and dilated colon (outer layer; white arrow). d An enema examination showed “crab’s claw sign” in the transverse colon.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508281&req=5

Fig1: Preoperative images. a Ultrasonography showed the “target sign” in the lower abdomen. b Enhanced CT revealed ileocolic intussusception and stretched mesenteric vessels. c The outer wall of the area of intussusception consisted of an edematous ileum (inner layer; black arrow) and dilated colon (outer layer; white arrow). d An enema examination showed “crab’s claw sign” in the transverse colon.
Mentions: An ultrasonography examination of the abdomen showed a target sign at the lower abdomen, indicating the existence of intussusception (Figure 1). Enhanced computed tomography (CT) also revealed ileocolic intussusception with a suspicious looking mass (Figure 1). In addition, an examination of abdominal CT performed at the previous clinic 5 weeks earlier made us suspicious of signs of ileocolic intussusception (Figure 2). Therefore, the initial appearance of the intussusception coincided with the beginning of his symptoms 5 weeks previously. We concluded that his symptoms were due to chronic intussusception, with an organic lead point. An attempt at hydrostatic reduction with gastrografin® (Bayer Yakuhin, Osaka, Japan) was not successful (Figure 1); therefore, an emergent operation was conducted.Figure 1

Bottom Line: The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg.Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery.Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501 Japan.

ABSTRACT
Chronic intussusception, defined as intussusception continuing over 14 days, is rare in children. We herein report a case of chronic ileocolic intussusception caused by the transmural infiltration of diffuse large B cell lymphoma in a 14-year-old boy. The patient had been suffering from anorexia and intermittent abdominal pain for 5 weeks, during which his body weight decreased by around 7 kg. Upon admission to our hospital, ultrasonography and enhanced computed tomography (CT) of the abdomen showed ileocolic intussusception. A retrospective examination of abdominal CT led us to suspect that the intussusception had initially appeared 5 weeks before admission, presumably coinciding with the beginning of the patient's abdominal symptoms. Since hydrostatic reduction was unsuccessful, laparotomy was performed, which showed unreducible ileocolic intussusception with a marked edematous ileum and mesentery. Ileocecal resection without lymph node dissection was carried out, and a histological examination of the resected specimen revealed the transmural infiltration of diffuse large B-cell lymphoma of the terminal ileum. The patient's postoperative course was uneventful, and adjuvant chemotherapy was administered. This case illustrates the diagnostic challenges of confirming 'chronic' intussusception in older children.

No MeSH data available.


Related in: MedlinePlus