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Getahun AM, Kedimu MW, Jember TD. Adult gastro-gastric intussusception; a case report. Int J Surg Case Rep 2025; 126:110711. [PMID: 39700579 PMCID: PMC11718279 DOI: 10.1016/j.ijscr.2024.110711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 11/29/2024] [Accepted: 11/29/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intussusception in the proximal bowel is extremely rare, with only a few reported cases of gastroduodenal intussusception (GDI). Gastrogastric intussusception is the rarest form of intussusception in adults. Here, we present an exceptionally rare case of gastro-gastric intussusception caused by a gastric Gastrointestinal Stromal Tumor (GIST). CASE PRESENTATION A 36-year-old male presented with acute abdominal pain, suggestive of intussusception. The preoperative evaluation was unable to pinpoint the exact location or cause of the intussusception. CLINICAL DISCUSSION Intraoperative diagnosis of gastro-gastric intussusception was made, and the patient was treated with a gentle reduction of the intussusception, followed by a distal gastrectomy with Billroth I anastomosis. He was relieved of his symptoms and has been recurrence-free for the past two years. CONCLUSIONS Gastro-gastric intussusception is an exceedingly rare type of foregut intussusception, which presents with non-specific clinical presentation and commonly occurs in the presence of an underlying pathology. A delay in diagnosis and treatment may be fatal, so a high index of suspicion and early surgical management is paramount.
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Affiliation(s)
- Amsalu Molla Getahun
- Department of Surgery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor 6300, Ethiopia.
| | - Mulugeta Wondmu Kedimu
- Department of Surgery, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor 6300, Ethiopia
| | - Tsion Dessalegn Jember
- Department of Public Health, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor 6300, Ethiopia
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Kim HJ, Fetz A, Sanders D, Woo E, Lam E. Ball-Valve Syndrome Secondary to Large Fundic Adenoma. ACG Case Rep J 2024; 11:e01330. [PMID: 38601722 PMCID: PMC11005892 DOI: 10.14309/crj.0000000000001330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Abstract
Gastroduodenal intussusception is a rare presentation in adults. A mass lesion in the stomach typically acts as a lead point that invaginates into the pylorus and duodenum causing intussusception. In a subset of these cases, episodic symptoms of obstruction occur because of intermittent prolapse of the lesion, termed "ball-valve syndrome." We present a 73-year-old woman with intermittent abdominal pain and nausea who was discovered to have gastroduodenal intussusception secondary to a large prolapsing fundic adenoma through the pylorus and into the duodenum. The case highlights this rare complication from gastric lesions along with the importance of surgical intervention for definitive management.
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Affiliation(s)
- Hyun Jae Kim
- Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Fetz
- Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Sanders
- Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emile Woo
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Lam
- Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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Wen J, Sharma VK, Lwin A, Beh JCY. Clinics in diagnostic imaging (204). Gastro-gastric intussusception due to gastric gastrointestinal stromal tumour (GIST). Singapore Med J 2021; 61:69-74. [PMID: 32152639 DOI: 10.11622/smedj.2020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 95-year-old woman presented with abdominal bloating and anorexia of one week's duration. Contrast-enhanced computed tomography (CT) revealed features in keeping with gastro-gastric intussusception with a lead mass. Oesophagogastroduodenoscopy demonstrated a large 5-cm pedunculated fundal mass intussuscepted into the distal stomach. The patient subsequently underwent endoscopic polypectomy and open gastrostomy. Histological evaluation of the gastric mass revealed a gastrointestinal stromal tumour. Her postoperative course was uneventful. We herein describe the radiological features of adult intussusception and illustrate the usefulness of CT in the detection and characterisation of lead masses.
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Affiliation(s)
- Jinhang Wen
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Vasu Keshav Sharma
- Department of Diagnostic Imaging, Ng Teng Fong General Hospital, Singapore
| | - Aung Lwin
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore
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Hsieh YL, Hsu WH, Lee CC, Wu CC, Wu DC, Wu JY. Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor: A case report and review of the literature. World J Clin Cases 2021; 9:838-846. [PMID: 33585630 PMCID: PMC7852652 DOI: 10.12998/wjcc.v9.i4.838] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric gastrointestinal stromal tumor (GIST) is the most common etiology of gastroduodenal intussusception. Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection, the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection (ESD) in Japan in 2017.
CASE SUMMARY An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month. Initially, she visited a local clinic for help, where abdominal sonography revealed a space-occupying lesion around the liver, so she was referred to our hospital for further confirmation. Abdominal sonography was repeated, which revealed a mass with an alternating concentric echogenic lesion. Esophagogastroduodenoscopy (EGD) was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet. EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found. Several differential diagnoses were suspected, including gastroduodenal intussusception, gastric cancer invasion to the duodenum, or pancreatic cancer with adherence to the gastric antrum and duodenum. Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb. Under the impression of gastroduodenal intussusception, ESD was performed at the base of the gastroduodenal intussusception; unfortunately, a gastric perforation was found after complete resection was accomplished, so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion. The gastric tumor was pathologically proved to be a GIST. After the operation, there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation.
CONCLUSION We present the second case of gastroduodenal intussusception caused by GIST treated by ESD. It is also the first case report of gastroduodenal intussusception by GIST in Taiwan, and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.
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Affiliation(s)
- Yi-Lun Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Ching-Chun Lee
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Jeng-Yih Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
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Caruso G, Caramma S, Zappalà A, Zerbo D, Evola G, Reina C, Reina GA. Acute intrathoracic gastric volvulus with retrograde gastric intussusception: A case report of a rare surgical emergency with review of the literature. Int J Surg Case Rep 2020; 72:381-385. [PMID: 32563826 PMCID: PMC7306532 DOI: 10.1016/j.ijscr.2020.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The gastric volvulus is a rare condition in which the stomach, or part of it, rotates on its axis, for over 180°, constituting a surgical emergency. Even more rare is gastro-gastric intussusception. A delay in their diagnosis and treatment can have fatal consequences PRESENTATION OF CASE: An 82-year-old woman was admitted to the Surgery Unit with a two-day history of abdominal pain associated at first with coffee vomiting and, subsequently, with unproductive retching and oligoanuria. Physical examination showed severe dehydration, fever, at the abdominal level, palpation caused a marked tenderness of all quadrants, with signs of peritonism. Laboratory test showed showed neutrophilic hyperleukocytosis and high C reactive protein level. Abdominal computed tomography revealed an acute intrathoracic gastric volvulus and a gastrogastric intussuception. The patient was submitted to exploratory laparotomy, subtotal gastrectomy with Roux en Y anastomosis and simple plastic of the esophageal hiatus. At the end of the surgery, however, the patient died of your septic shock. DISCUSSION The traditional treatment for a patient with acute gastric volvulus is an immediate surgical intervention to derotate the stomach and prevent vascular insufficiency. In the presence of necrosis or gastric perforation, resection should be performed. The few cases of gastrogastric intussusception described in the literature have been treated with sub-total gastrectomy and gastro-jejunal anastomosis. Any delay in diagnosis and treatment can prove fatal. CONCLUSION Intrathoracic Gastric Volvulus and, even more, retrograde gastrointestinal intussusception are very rare pathologies, difficult to diagnose.
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Affiliation(s)
- Giovambattista Caruso
- General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy.
| | - Sebastiano Caramma
- General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy
| | - Angelo Zappalà
- General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy
| | - Domenico Zerbo
- General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy
| | - Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy
| | - Carlo Reina
- General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy
| | - Giuseppe Angelo Reina
- General Surgery Department, Santissimo Salvatore Hospital (ASP Catania), Paternò, Catania, Italy
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Zhornitskiy A, Le L, Tareen S, Abdullahi G, Karunasiri D, Tabibian JH. Gastro-gastric intussusception in the setting of a neuroendocrine tumor: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zhornitskiy A, Le L, Tareen S, Abdullahi G, Karunasiri D, Tabibian JH. Gastro-gastric intussusception in the setting of a neuroendocrine tumor: A case report. World J Clin Cases 2019; 7:3517-3523. [PMID: 31750333 PMCID: PMC6854402 DOI: 10.12998/wjcc.v7.i21.3517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/23/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND While in children intussusception is often idiopathic, in adults it is commonly caused by a pathologic condition functioning as a lead point. It is important to note that a variety of pathologic conditions may trigger intussusception, with malignancy being a relatively frequent culprit in adults; this should be considered high on the differential diagnosis during evaluation. CASE SUMMARY This is a case of a 40-year-old female presenting to the emergency department (ED) with three days of acute on chronic, peri-umbilical abdominal pain described as waxing and waning, and pressure-like in nature. Initial computed tomography (CT) of the abdomen and pelvis with contrast in the ED (after her pain had resolved) re-demonstrated a previously noted 13 mm lesion in the gastric antrum but no clear cause of the pain. Endoscopic ultrasound was pursued, and the mass lesion was sampled via fine needle biopsy. Post-procedure the patient experienced another episode of severe pain which prompted a repeat stat CT abdomen and pelvis with contrast; this re-demonstrated the 13 mm antral lesion and in addition was remarkable for a gastro-gastric intussusception. An upper gastrointestinal gastrograffin series was ordered (completed only after the pain had subsided) and showed resolution of the intussusception. Histopathology was consistent with a diagnosis of low-grade neuroendocrine tumor (NET). Surgery was initially deferred during the hospitilization given the low grade pathology of the lesion; however further multidisciplinary discussion between Surgery, Oncology, and Gastroenterology recommended resection given the patient's recurrent abdominal pain with the NET functioning as a lead point for further intussusception, and the patient thus underwent robotically-assisted wedge resection. CONCLUSION We present a unique case of severe, intermittent, peri-umbilical pain related to gastro-gastric intussusception caused by an antral NET lead point. The case highlights the importance of considering neoplasms as the cause of intussusception in adults and the greater diagnostic yield when imaging is obtained while symptoms (in this case severe, episodic abdominal pain) are most apparent.
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Affiliation(s)
- Alex Zhornitskiy
- Department of Internal Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| | - Long Le
- Department of Internal Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| | - Serene Tareen
- Department of Internal Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| | - Gezman Abdullahi
- Department of Internal Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| | - Deepthi Karunasiri
- Department of Pathology and Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
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Behrooz A, Cleasby M. Gastrogastric intussusception in adults: a case report with review of the literature. BJR Case Rep 2018; 4:20180006. [PMID: 30931134 PMCID: PMC6438400 DOI: 10.1259/bjrcr.20180006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/26/2018] [Accepted: 05/10/2018] [Indexed: 01/02/2023] Open
Abstract
Intussusception of the gastrointestinal viscera is rarely encountered in adult patients and is frequently associated with a polypoidal lead point, which is often malignant. We would like to present the case of a 68-year-old male with a history of decompensated liver disease and multiple medical comorbidities, who was discovered to have an incidental gastrogastric intussusception on CT. No polypoidal lead point was seen and we believe this to be the first case of its kind to be described. We suggest that distortions in the patient’s visceral and vascular anatomy and raised intra-abdominal pressure resulting from concomitant ascites, hiatus hernia, portal hypertension and oesophageal varices have provided an alternative mechanism for a gastrogastric intussusception to develop.
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Affiliation(s)
- Arash Behrooz
- Department of Pathology, Worcestershire Royal Hospital, Worcester, UK
| | - Morgan Cleasby
- Department of Radiology, Good Hope Hospital, Birmingham, UK
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Karegowda LH, Rajagopal K, Shastry P, Deevi HK. Imaging appearance of malignancy associated gastrogastric intussusception in an elderly woman. BMJ Case Rep 2018; 2018:bcr-2018-225267. [PMID: 29728438 DOI: 10.1136/bcr-2018-225267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Kadavigere Rajagopal
- Department of Radio Diagnosis, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Karnataka, India
| | - Praveen Shastry
- Department of Radio Diagnosis, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Karnataka, India
| | - Hemanth Kumar Deevi
- Department of Radio Diagnosis, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Karnataka, India
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Jo HH, Kang SM, Kim SH, Ra M, Park BK, Kwon JG, Kim EY, Jung JT, Kim HG, Ryoo HM, Kang UR. [A Case of Gastro-Gastric Intussusception Secondary to Primary Gastric Lymphoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 68:40-4. [PMID: 27443623 DOI: 10.4166/kjg.2016.68.1.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy.
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Affiliation(s)
- Hyeong Ho Jo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sun Mi Kang
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Si Hye Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Moni Ra
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Byeong Kyu Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Joong Goo Kwon
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Tae Jung
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ho Gak Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hun Mo Ryoo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ung Rae Kang
- Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, Korea
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