Adult Intestinal Intussusception Caused by an Inflammatory Myofibroblastic Tumor
A 79-year-old man presented to our hospital with a 3-month history of nausea, constipation and abdominal distention. Laboratory tests were within normal range. Abdominal ultrasonography revealed a 5-cm mobile, well-defined, elastic hard mass in the left upper quadrant of the abdomen. Ultrasonographic images in the transverse plane showed multiple concentric ring sign (fig. ). In the longitudinal section, multiple parallel lines provided the so-called ‘sandwich appearance’, and a 3.5-cm solid mass was observed in the presenting part (fig. ). In addition, color Doppler ultrasonography showed abundant blood flow surrounding the mass. Computed tomography (CT) revealed an enhanced homogeneous mass and slight dilatation of the oral side of the intestine (fig. ). Based on these findings, we diagnosed the patient with intussusception caused by an intestinal tumor. We performed elective laparotomy that revealed an ileal intussusception located 80 cm proximal to the end of the ileum. The intussusception was found to be caused by an ileal tumor located 70 cm from Bauhin's valve. We partially resected the ileum maintaining a 10-cm margin from the tumor, and ileo-ileal anastomosis was performed in an end-to-end manner (fig. ). The tumor was a homogeneous solid mass, 3.5 × 2.5 cm in diameter, and was well-circumscribed and grayish-white in color (fig. ). Histopathological examination of the tumor revealed proliferation of spindle-shaped cells with infiltration of plasma cells and lymphocytes (fig. ). Pathologically, the tumor was diagnosed as an IMT of the small intestine. The patient had no tumor recurrence 12 months after surgery.