A case report of recurrent intussusception caused by small bowel lymphangioma in an adult. (2020)

• Record Type: Journal Article
• Authors: Akashige, Toru; Sato, Kota; Odajima, Hajime; Yamazaki, Shigeru
• Is Part Of: International journal of surgery case reports. Volume 75(2020)
• Page Start: 126
• Page End: 130
• Publication Date: 2020
• Subjects: Case report -- Adult intussusception -- Small bowel lymphangioma -- Abdominal distension -- Abdominal pain -- Adhesive small bowel obstruction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.09.030
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Lymphangioma is a benign tumor that rarely arises in gastrointestinal tract. Small bowel lymphangioma can cause intussusception in adults. The symptoms of small bowel intussusception in adults resemble those of adhesive small bowel obstruction. Reduction is not sufficient and surgical resection of affected bowel should be performed. Abstract: Introduction: Adult intussusception and lymphangioma in gastrointestinal tract are uncommon entities respectively. Recurrent intussusception due to lymphangioma of the small intestine is extremely rare and mimics adhesive small bowel obstruction (SBO). Presentation of case: A 37 year old man presented with acute abdominal pain and vomiting. He had been admitted several times for adhesive SBO after laparoscopic cholecystectomy at age 21. He was initially managed with a long tube placement, with which he used to get well. This time, the symptoms once relieved but soon relapsed, so an exploratory laparotomy was performed. Intraabdominal adhesiolysis was performed alongside the excision of a small segment of damaged jejunum. Intussusception of jejunum was noted and its reduction was also performed. Unfortunately, the symptoms continued after the operation, and computed tomography revealed a recurred intussusception of the jejunum. A reoperation with an additional resection of small intestine surrounding intussusception was performed. The symptoms subsided after the second operation and the patient was discharged. Pathological examination revealed lymphangioma within the affected lumen. Discussion: Intussusception in an adult is often caused by a tumor but can be caused by postoperative adhesion. The reduction is a potential option of treatment if there is no tumor suspected, but sometimes it would be uneasy to affirm the non-existence of tumors. Conclusion: We present this rare case of recurrent jejuno-jejunal intussusception caused by small bowel lymphangioma with review of literature. Taking the possibility of recurrence and malignancy into account, the resection should always be considered in such patients.