BACKGROUND: Intussusception is defined as the telescoping of a segment of the gastrointestinal tract into an adjacent one. A demonstrable etiology is found in 70% to 90% of cases in adult patients, and about 40% of them are caused by a primary or secondary malignant tumor. The aims of this study were to give an overview of the literature on intussusception due to gastrointestinal lymphoma. MATERIALS AND METHODS: We present a case of ileocecal intussusception secondary to non-Hodgkin's lymphoma (NHL), as well as a liter- ature review of studies published in the English language on intussusception secondary to lym- phoma, accessed through PubMed and Google Scholar databases. RESULTS:Thirty-six published cases of intussus- ception caused by lymphoma were evaluated,and a case of ileocecal lymphoma in a 62 year-old woman is herein presented.In the reviewed literature,33 re- ports meeting the aforementioned criteria were in- cluded in this review.The patients were aged from 16 to 86 years (mean, 48.2 +/- 19.0 y).Twenty-nine were male and seven were female.According to the localization of lymphoma, 24 patients had ileo-colic intussusception, 10 had enteric, and 2 had colic in- tussusception. In terms of the diagnosis, 34 pa- tients were diagnosed with various types of NHL, and two patients were diagnosed with HL. CONCLUSIONS: Despite the rarity of intussus- ception cases secondary to malignant causes, particularly lymphoma, it is rather difficult to di- agnose preoperatively by surgeons. Because there exists a risk of malignancy in a substantial portion of adult intussusception cases, resec- tion should be performed in a manner consistent with the oncological principles.

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Unusual cause of adult intussusception: diffuse large B-cell non-Hodgkin's lymphoma: a case report and review

Clinical Presentations and Surgical Approach of Acute Intussusception Caused by Peutz–Jeghers Syndrome in Adults

Adult intussusception is a rare clinical condition worldwide. It contributes to less than 5% of all cases of intussusception. Few studies have been conducted in low-income countries compared to high-income countries; particularly Sub-Saharan Africa. Based on anecdotal evidence, the authors hypothesized that the condition is not as rare in a Sub-Saharan setting in comparison with western countries. We set out to conduct the first review study of adult intussusception in Uganda. The medical records of 37 (out of a total of 62 cases) adolescent and adult patients with a postoperative diagnosis of intussusception at Mulago National Referral and Teaching Hospital, from January 2003 to December 2012, were analyzed. The clinical features, diagnosis, treatment and pathologic features of lesions for these patients were reviewed. Intraoperative findings were described with reference to: the site of the intussusception, and the triggering lesion (either idiopathic or with a lead point). The mean age was 33.6 years, with a range of 13 – 72 years. The male to female ratio was 1.85:1. The mean number of days for which symptoms had been present prior to presentation was 6.3 days, while the median was 4 days. All 37 patients presented with abdominal pain. Only 13 (35.1%) had the classical paediatric triad of abdominal pain, a palpable abdominal mass and bloody stool. Most of the remaining patients presented sub-acutely with non-specific symptoms. A lead point was present in 28 patients (75.7%). Of these, 24 (64.9%) cases involved tumours. Among the tumours, 54.2% were malignant. Treatment did not involve intussusception reduction in 14 patients (37.8%). Some form of operative surgery was conducted in 31 (83.8%) patients; mainly segmental bowel resections and hemi-colectomies. Adult intussusception is uncommon in the Uganda, though probably less so than in western countries. It presents sub-acutely or chronically and is often diagnosed at laparotomy. Lead points are the triggering lesion most times and are due mainly to tumours. The bulk of tumours are malignant. Most patients require surgical resection, with prior reduction done in selected cases.

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Presentation, aetiology and treatment of adult intussusception in a tertiary Sub-Saharan Hospital: a 10-year retrospective study

Intussusception is an uncommon cause of abdominal pain in adults and poses diagnostic challenges for emergency physicians, due to its varied presenting symptoms and time course. Diagnosis is thus often delayed and results in surgical intervention due to the development of bowel ischaemia. We report on a young patient who presented with an ileo-ileal intussusception in whom there were no underlying lesions identified as a causal factor.

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Idiopathic adult intussusception

We present a rare case of gastrogastric intussusception due to gastrointestinal stromal tumor (GIST) and the largest comprehensive literature review of published case reports on gastrointestinal (GI) intussusception due to GIST in the past three decades. We found that the common presenting symptoms were features of gastrointestinal obstruction and melena. We highlight the diagnostic challenges faced in low-resource countries. Our findings emphasize the importance of early clinical diagnosis in low-resource settings in order to guide timely management. In addition, histological analysis of the tumor for macroscopic and microscopic characteristics including mitotic index and c-Kit/CD117 status should be obtained to guide adjuvant therapy with imatinib mesylate. Periodic follow-up to access tumor recurrence is fundamental and should be the standard of care.

/pdf/adult-intussusception-due-to-gastrointestinal-stromal-tumor-3s2qoe8zwb.pdf

Adult Intussusception due to Gastrointestinal Stromal Tumor: A Rare Case Report, Comprehensive Literature Review, and Diagnostic Challenges in Low-Resource Countries.

Background: Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30–1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. Methods: The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. Results: All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy (lymphoma) as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis (2-3 weeks prior) was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. “Target lesion” and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. Conclusion: Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical. Key words: Adult Intussusception

/pdf/adult-intussusception-a-surgical-dilemma-3l00yhozxe.pdf

Adult intussusception – a surgical dilemma

https://www.jcpsp.pk/oas/mpdf/generate_pdf.php?string=QlpLMkN0WUJjcmZ6T3RGUmtEaGNpZz09

Welcoming the First Magnetic Resonance-Integrated Linear Accelerator in Pakistan.

PURPOSE When combined with radiotherapy, limb salvage surgery is an alternative to amputation. This study sought to determine the limb-sparing treatment outcomes in patients diagnosed with soft tissue extremity sarcomas treated at our institution. MATERIALS AND METHODS All adult patients with extremity soft tissue sarcoma treated with the radical limb salvage strategy at Shaukat Khanum Memorial Cancer Hospital and Research Canter, Lahore, Pakistan, between January 2017 and December 2019 were retrospectively assessed. RESULTS A total of 122 patients were included in the study. The mean age was 42 years (range 19-82), and 64 (52.5%) were males. The majority of patients, 65 (53.3%), were diagnosed with stage III and grade III disease according to American Joint Committee on Cancer TNM classification (Eighth edition). The most common surgical modality was wide local excision that was performed in 106 (86.9%) patients. Adjuvant radiation treatment was given in 111 (91%) patients, whereas 11 (9%) patients received neoadjuvant radiation treatment. The mean dose was 58 Gy (range: 46-66 Gy). Eighty-two (67.2%) of the patients were disease-free on post-treatment radiologic scans with disease recurrence observed in 40 (32.8%) patients. The median disease-free survival was 8 months (95% CI, 5.45 to 10.55). Local recurrence and distant metastases developed in 16 (13%) and 24 (20%) patients, respectively. CONCLUSION About two thirds of patients with extremity soft tissue sarcoma were successfully treated with limb salvage strategy, surgery, and radiation therapy. However, high rate of relapse warrants further novel strategies in this patient population.

Radiotherapy and Limb-Sparing Surgery in the Management of Localized Soft Tissue Sarcomas: Tertiary Care Center Experience From Pakistan

Reply to A. Mangla.

Synovial Sarcoma (SS) is a rare soft-tissue malignant tumour. Its presentation in the head and neck region is uncommon. Because of the complex anatomy of the head and neck region, surgery with clear margins is not achievable. In such cases, a multi-modality approach is required as there is no established standard of care. In this report, we share the case of a girl who presented with nasal obstruction. Imaging revealed a mass involving the left nasal cavity, paranasal sinuses without intracranial extension. It was diagnosed as synovial sarcoma. She underwent surgical excision and adjuvant radiation therapy (RT) to the tumour bed, followed by an incomplete course of chemotherapy. Later on, she developed systemic disease. Considering the rarity of this case and lack of guidelines for standard treatment, we report on this case to share our experience with management and treatment outcome.

M Mansha

Papers

Adult intussusception – a surgical dilemma

Welcoming the First Magnetic Resonance-Integrated Linear Accelerator in Pakistan.

Radiotherapy and Limb-Sparing Surgery in the Management of Localized Soft Tissue Sarcomas: Tertiary Care Center Experience From Pakistan

Reply to A. Mangla.

Synovial sarcoma: a rare neoplasm of paranasal sinus.