EP 373 When a Rare Entity Triggered a Rare Emergency: Case Report of a Leiomyosarcoma as the Aetiology of an Ileo-Ileal Intussusception
Manas Manoj Potdar, Amanda Barden, Anang Pangeni, Kopinath Kathirvetpillai, Ashish ShresthaAbstract
Introduction & Importance
Intussusception is the telescoping of a gastrointestinal tract segment into a distal segment. A lead point (LP), a lesion within the intestinal wall, protrudes into the distal bowel during peristalsis, along with the proximal bowel. An LP is identified in most adult cases of intussusception, with neoplasms accounting for 60% of these. We present a rare case of an ileo-ileal intussusception in which a leiomyosarcoma (LMS) served as the LP.
Case Description
A 60-year-old man presented to his GP with abdominal pain, nausea, constipation, vomiting, and fourteen-pound weight loss over ten days. This prompted the GP to arrange a CT abdomen and pelvis (CTAP). Days later, he attended Accident & Emergency (A&E) with persistent symptoms and was referred to the surgical department. The CTAP was reported three days before his A&E visit, showing intussusception. Laparoscopic-assisted resection of the affected bowel segment and healthy bowel anastomosis was performed. Recovery was uneventful, and he was discharged three days postoperatively. Histopathology and immunohistochemistry confirmed LMS.
Case discussion
5% of intussusception cases occur in adults, while the remaining cases occur in children. Intussusception accounts for ∼1% of small bowel obstruction cases, with an intraoperative incidence of 1:1300. Small bowel malignancies comprise <5% of gastrointestinal cancers, and LMSs represent <2% of these.
Conclusion
Intussusception and small bowel malignancies (e.g. adenocarcinomas) are uncommon pathologies in themselves. Among these malignancies, LMSs represent an even rarer occurrence. This case highlights the exceptional rarity of a small bowel LMS serving as the LP for intussusception.