Adult Duodenojejunal Intussusception Involving the Pancreas: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

Intussusception is defined as one segment of bowel telescoping into an immediately adjacent segment of bowel and when presenting as an obstruction, patients typically note bloating, obstipation, nausea, vomiting, and oral intolerance (1, 2). Intussusception is a rare cause of small bowel obstruction (SBO) in adult patients, representing only 1-5% of cases. In adults, the lead point often represents a tumor and is most commonly found in the ileocolic region. Duodenojejunal intussusception representing an even rare of SBO. Currently, the mainstay of treatment is operative intervention (3, 4). Here, we describe a very rare case of intussusception occurring in the duodenum including the pancreatic head which is scarcely documented in the literature.The patient is a 66-year-old healthy, active female with no past medical history who presented to the surgery office after being hospitalized for nausea, vomiting, and epigastric abdominal pain thought to be secondary to a 4.6cm leiomyoma. Unfortunately, over the next four months, the patient experienced a 50-pound weight loss and was scheduled for an elective duodenal leiomyoma resection. For monitoring and operative planning, the patient had an outpatient CT scan which showed the duodenal mass had grown to be 7.5 cm. The intussusception now included the pancreatic head and common bile duct. Given significant progression expedited admission was recommended due to concerns that complications would delay the patient from definitive operative intervention. At time of admission, laboratory workup revealed a lipase of 44 (normal <50 U/L), alkaline phosphatase 79 (normal 35-104 U/L), ALT 8 (0-35 U/L), AST <10 (0-35U/L), total bilirubin 0.2 (0.2-1.0 mg/dL) and WBC 7.8 (4-10.8x10*9L).

Patient underwent an exploratory laparotomy with duodenotomy and duodenal mass excision. The mass did not involve the ampulla intraoperatively and appeared to be a smooth, pedunculated oval shaped mass along the anterolateral wall of the D2 segment of the duodenum.   In addition, the patient underwent a cholecystectomy, intraoperative ultrasound of the bile ducts and gallbladder. Final pathology confirmed duodenal leiomyoma. Post operatively, the patient recovered extremely well without concerns. She remained in the hospital for 4 days postoperatively awaiting return of bowel function and slowly progressing her diet. She underwent a slow diet advance and has had no further issues.

Intussusception is a rare cause of small bowel obstruction in adults, typically occurring as a warning sign that insidious pathology is present. This case represents a rare case of duodenojejunal intussusception involving the pancreas. To our knowledge, this is only the third case reported in the literature. Acknowledging this as a rare but possible complication to intussusception is important in the management of patients with this pathology as complications such as pancreatitis can prevent patients from reaching their destination therapy in a timely manner.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1683

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