Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2019; 7(14): 1857-1864
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1857
Duodenal intussusception secondary to ampullary adenoma: A case report
Masaaki Hirata, Yoshiharu Shirakata, Kenya Yamanaka
Masaaki Hirata, Yoshiharu Shirakata, Kenya Yamanaka, Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
Author contributions: Hirata M, Shirakata Y and Yamanaka K contributed to writing and revising the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Corresponding author: Masaaki Hirata, MD, Surgeon, Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, Hyogo 660-0892, Japan. mhirata6341@gmail.com
Telephone: +81-6-64807000 Fax: +81-6-64807001
Received: April 1, 2019
Peer-review started: April 1, 2019
First decision: April 30, 2019
Revised: May 13, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: July 26, 2019
Processing time: 117 Days and 2.2 Hours
Abstract
BACKGROUND

Because the duodenum is fixed onto the retroperitoneum, duodenal intussusception is usually impossible except in cases of malrotational abnormality. Although cases of duodenal intussusception without malrotational abnormalities have been reported, it is unclear whether they constitute true intussusception or simple mucosal prolapse.

CASE SUMMARY

A 66-year-old woman presented with whole-body edema and malaise. Blood analysis indicated severe anemia and cholestasis. Endoscopic examination revealed a pedunculate polyp on the second part of the duodenum that migrated distally with mucosal elongation. Computed tomography showed duodenal intussusception. A tumor as the lead point and retroperitoneal structure, including the head of the pancreas and fat, invaginated beyond the duodenojejunal flexure. She was diagnosed with ampullary adenoma caused repeated intussusception that reduced spontaneously and underwent pancreaticoduodenectomy. Laparotomy showed tumor prolapse beyond the duodenojejunal flexure without intussusception. There was no evidence of malrotational abnormality. She was discharged with no complications.

CONCLUSION

We report true duodenal intussusception without malrotational abnormality. This phenomenon was also associated with mucosal prolapse.

Keywords: Duodenal intussusception; Mucosal prolapse; Ampullary adenoma; Case report

Core tip: Duodenal intussusception is usually impossible except in cases of malrotational abnormality. Some cases of duodenal intussusception without malrotational abnormalities have been reported, but it is unclear whether this phenomenon is true intussusception or simple mucosal prolapse. We present a case of true duodenal intussusception secondary to ampullary adenoma without malrotational abnormality. Computed tomography showed a tumor as the lead point and retroperitoneal structure, including the head of the pancreas and fat, invaginating beyond the duodenojejunal flexure to the jejunum. This phenomenon was associated with mucosal prolapse.