Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.688
Peer-review started: June 5, 2014
First decision: July 9, 2014
Revised: September 4, 2014
Accepted: September 30, 2014
Article in press: September 30, 2014
Published online: January 14, 2015
Intussusception is rarely reported in adult patients with acute leukemia. We report a case of intussusception in a 29-year-old woman with acute myeloid leukemia (AML). She developed right lower quadrant pain, fever, and vomiting on day 16 of induction chemotherapy. Physical examination showed tenderness and guarding at the right lower quadrant of the abdomen. Abdominal computed tomography (CT) showed distension of the cecum and ascending colon, which were filled with loops of small bowel, and herniation of the ileocecal valve into the cecum. We proceeded to laparotomy and revealed ileocecal intussusception with the ileocecal valve as the leading point. The terminal ileum was thickened and invaginated into the cecum, which showed gangrenous changes. Right hemicolectomy was performed and microscopic examination of the colonic tissue showed infiltration of leukemic cells. The patient recovered after the operation and was subsequently able to continue treatment for AML. This case demonstrates that the diagnosis of intussusception is difficult because the presenting symptoms can be non-specific, but abdominal CT can be informative for preoperative diagnosis. Resection of the involved bowel is recommended when malignancy is suspected or confirmed. Intussusception should be considered in any leukemia patients presenting with acute abdomen. A high index of clinical suspicion is important for early diagnosis.
Core tip: Gastrointestinal complications are common in patients with acute leukemia, but intussusception is rarely reported in adult leukemia patients. Previous reports have mainly been in children with leukemia. We report a case of intussusception in an adult after chemotherapy for acute myeloid leukemia (AML). A 29-year-old woman with AML presented with fever, vomiting and right lower quadrant pain. Abdominal computed tomography showed features of intussusception. Resection of the involved bowel was performed and the patient recovered from the operation. A high index of clinical suspicion is important for early diagnosis.