Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2015; 21(2): 688-693
Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.688
Rare case of intussusception in an adult with acute myeloid leukemia
Man Fai Law, Cheuk Kei Wong, Chun Yin Pang, Hay Nun Chan, Ho Kei Lai, Chung Yin Ha, Celia Ng, Yiu Ming Yeung, Sze Fai Yip
Man Fai Law, Hay Nun Chan, Ho Kei Lai, Chung Yin Ha, Celia Ng, Yiu Ming Yeung, Sze Fai Yip, Department of Medicine, Tuen Mun Hospital, Hong Kong, China
Man Fai Law, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
Cheuk Kei Wong, Department of Radiology, Kwong Wah Hospital, Hong Kong, China
Chun Yin Pang, Department of Pathology, Tuen Mun Hospital, Hong Kong, China
Author contributions: Law MF, Chan HN, Lai HK, Ha CY, Ng C, Yeung YM and Yip SF designed the study and analyzed the data; Law MF wrote the paper; Wong CK and Pang CY prepared the illustrations and wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Man Fai Law, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30-32 Shatin, Hong Kong, China. mflaw99@yahoo.com.hk
Telephone: +852-97763090
Received: June 4, 2014
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
Abstract

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.

Keywords: Intussusception, Acute leukemia, Abdominal pain, Colon, Malignancy

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.