Small bowel intussusception due to sarcoma metastasis

Case contributed by Mark Sugi
Diagnosis almost certain

Presentation

Chronic anemia in the setting of metastatic sarcoma.

Patient Data

Age: 60 years
Gender: Male

IV and positive enteric contrast-enhanced CT images show a small bowel-small bowel intussusception due to a sarcoma metastasis in the distal jejunum. The intussuscepted loop of bowel (intussusceptum) extends left to right in the central abdomen and terminates with a lead-point mass. The mesenteric fat and vasculature can be seen posterior to the loop of intussuscepted bowel. On axial and coronal images, the intussusception appears as "bowel within bowel." On sagittal images, the layers of bowel in both the intussusceptum and intussuscipiens (distal bowel) form concentric rings. The use of positive enteric contrast in this case nicely highlights the length of the intussusception.

Additional pulmonary, mesenteric and retroperitoneal nodal metastases.

A long thrombus is seen within the left iliac vein. 

Case Discussion

The patient underwent exploratory laparotomy and small bowel resection with primary anastomosis.
Small bowel intussusception is most commonly transient and clinically insignificant, often seen incidentally in the proximal jejunum on routine CT performed for other purposes. It has also been described in the setting of celiac and Crohn disease.

Rarely a primary small bowel neoplasm or metastasis can serve as a lead-point that eventually results in intussusception and subsequent small bowel obstruction. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract that may cause distal ileal or ileocolic intussusception.

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