Acute Intestinal Obstruction Due to Ileocolic Intussusception in an Adult; A Rare Presentation of Inflammatory Myofibroblastic Tumor

Abstract

BACKGROUND Intussusception is not very common in adults, and acute intestinal obstruction with intussusception due to inflammatory myofibroblastic tumor (IMT) is extremely rare. IMT is an uncommon lesion and has no single defined cause. It predominantly affects the pediatric age group and commonly involves the lungs. Here we present a case of IMT causing ileocolic intussusception leading to acute intestinal obstruction in an adult. CASE REPORT A 40-year-old female came to the emergency department with severe colicky pain in her abdomen, and reported 6 to 7 episodes of vomiting with bilious contents, along with an inability to pass feces and flatus for 3 days. An x-ray of her abdomen in erect posture revealed multiple air-fluid levels. Because she had a previous history of tuberculosis, a possible tubercular stricture as the cause of her acute obstruction was considered; an exploratory laparotomy was performed showing her bowel loops were dilated with ileocolic intussusception. The lead point of intussusception (a well-defined 4×4×3.5 cm solid mass), was found at 15 cm proximal to the ileocecal junction. A right hemicolectomy with ileo-transverse anastomosis was performed. The histopathological examination confirmed the presence of IMT. CONCLUSIONS IMT causing ileocolic intussusception with acute intestinal obstruction is an extremely rare presentation of an uncommon entity in adults. High index of suspicion, and appropriate investigations (x-ray abdomen, ultrasound, computed tomography, and colonoscopy) depending on presentation and clinical condition of the patient can result in prompt diagnosis and early management.

Figure 1.

Radiograph showing small bowel obstruction.

Figure 2.

Intraoperative photograph of ileocolic intussusception.

Figure 3.

Gross image of resected specimen showing lead point of intussusception marked by arrow.

Figure 4.

Cross section of ileum showing solid, rounded tumor.

Figure 5.

Proliferation of spindle cells – myofibroblasts and fibroblasts in a background of mixed inflammatory infiltrate with eosinophils and edematous vascularized stroma.