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The Turkish Journal of Gastroenterology
2013, Volume 24, No 1, Pages 78-79
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Adult intussusception and gastrointestinal bleeding due to an isolated heterotopic pancreas
Zhen WU, Hong ZHANG, Zhe SHEN, You-MING LI
Department of Gastroenterology, The First Affiliated Hospital, Hangzhou, China
Summary
Intussusception is uncommon in adults when compared against children. Adult intussusception represents 5% of all cases of intussusception, and accounts for only 1%-5% of intestinal obstructions in adults (1). In children, 90% of cases are idiopathic. In contrast, intussusception in adults is generally secondary to a pathologic condition such as carcinomas, polyps, Meckel’s diverticulum, colonic diverticulum, strictures or benign neoplasms (2). Heterotopic pancreas is a very rare cause of adult intussusception, and has rarely been mentioned before in the literature (3, 4). There is no known case presented in literature that mentions both intussusception and gastrointestinal bleeding in the same patient. A 45-year-old man without a remarkable past medical history presented with a one month history of intermittent abdominal pain with associated nausea and vomiting. Physical examination revealed right lower quadrant tenderness. No masses were palpable. Results of initial laboratory tests were unremarkable. Plain abdominal film showed a dilated small bowel and associated air fluid levels indicative of a small-bowel obstruction. Computed tomography scans of the abdomen revealed an ileal intussusception. A nodule with an abundant fatty component was noted in the computed tomography scan (Figure 1), which included several strips of high density inside, and was identified at the proximal end of the intussusception. The initial diagnosis was ileal intussusception due to a lipoma. An emergency laparotomy was performed due to the presence of melena, with an associated drop of hemoglobin to 10 g/dL. At laparotomy, an ileoileal intussusception was noted approximately 60 cm from the ileo-cecal valve. Segmental resection of the ileum with ileoileostomy was completed. An enterotomy confirmed the presence of a pedunculated nodule (60 mm by 18 mm) with fatty tissue inside. The patient went on to a rapid recovery, with complete resolution of his symptoms. Microscopically, the nodule was composed of ectopic pancreatic tissue. A final pathological diagnosis of heterotopic pancreas with intussusception was determined. Heterotopic pancreas is a very rare cause of adult intussusception. Heterotopic pancreas is usually associated with the diagnosis of Meckel's diverticulum (3). Isolated heterotopic pancreas in the ileum caused by adult intussusception is extremely rare. Preoperative diagnosis is difficult because of its longstanding, intermittent, and generally nonspecific symptoms. The classic pediatric presentation of acute intussusception (a triad of cramping abdominal pain, bloody diarrhea, and a palpable tender mass) is rare in adults (2). Many cases are misdiagnosed and ultimately diagnosed at emergency laparotomy. In this case, the patient presented with both small bowel obstruction and gastrointestinal bleeding, which to our knowledge has never been priorly reported in the literature. Computed tomography proves to be an effective preoperative diagnostic method. Local resection of the heterotopic tissue is the current appropriate indicated treatment for this condition (5).
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    1. Gupta RK, Agrawal CS, Yadav R, et al. Intussusception in adults: institutional review. Int J Surg 2011;9:91-5. 2. Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15:407-11. 3. Chandra N, Campbell S, Gibson M, et al. Intussusception caused by a heterotopic pancreas. Case report and literature review. JOP 2004;5:476-9. 4. Gurbulak B, Kabul E, Dural C, et al. Heterotopic pancreas as a leading point for small-bowel intussusception in a pregnant woman. JOP 2007;8:584-7. 5. Fikatas P, Sauer IM, Mogl M, et al. Heterotopic ileal pancreas with lipoma and coexisting fibromatosis associated with a rare case of gastrointestinal bleeding. A case report and review of the literature. JOP;9:640-3.
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