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Ileoileal intussusception caused by a Ewing sarcoma tumour. An unusual case report
1Paediatric Surgical Department, University of Munich, Munich, Germany. roland.boehm@kk-i.med.uni-muenchen.de
Insights
Intussusception is rare in adolescents but can be caused by a small bowel tumor. This case highlights Ewing sarcoma as a potential cause of intussusception in young adults.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Intussusception is common in children but rare in adolescents and adults, often presenting with vague symptoms.
- A leading point, such as a tumor, is the cause of intussusception.
- Diagnosis in older patients can be challenging due to low incidence and variable symptoms.
Observation:
- An 18-year-old male presented with weeks of abdominal discomfort, colics, vomiting, dehydration, and weight loss.
- Initial diagnostics were inconclusive, misinterpreting symptoms as intestinal motility issues.
- Clinical and radiological signs of ileus necessitated exploratory laparotomy.
Findings:
- Ileoilealic intussusception was identified during laparotomy.
- The intussusception was caused by a small bowel tumor obstructing the intestinal lumen.
- Histopathology confirmed a rare, highly malignant mesenchymal Ewing sarcoma infiltrating the bowel wall.
Implications:
- This case underscores the importance of considering intestinal malignancies in adolescents with chronic, nonspecific abdominal obstruction symptoms.
- Ewing sarcoma, though rare, should be included in the differential diagnosis for intussusception in this age group.
- Prompt diagnosis and surgical intervention followed by oncological treatment are crucial for managing such rare presentations.
Abstract:
Intussusception typically occurs in childhood, presenting with a well-known medical history and clinical symptoms. Pathologically, a "leading point" may be attributed to lymphadenomatosis, polyps, or a tumour. In older patients and adolescents, the diagnosis can be complicated due to the lower incidence and variable subacute symptoms. We report on an 18-year-old patient with increasing abdominal discomfort over several weeks. External diagnostics showed no pathological signs or were misinterpreted as a malfunction of intestinal motility. The patient experienced increasing colics, recurrent vomiting, dehydration and weight loss. Finally he was transferred to our paediatric surgical department and laparotomy had to be performed for the clinical and radiological signs of an ileus. An ileoilealic intussusception was found, caused by a small bowel tumour, which almost completely obstructed the intestinal lumen. It was resected and bowel continuity was re-established. Histopathology revealed a very rare, highly malignant mesenchymal Ewing sarcoma, infiltrating the complete bowel wall. After the postoperative course, the patient was transferred to our oncological department for chemotherapy. In older children or young adults, intestinal malignancies are extremely rare. Nevertheless, if these patients suffer from unspecific complaints of chronic intestinal obstruction, a tumour must be ruled out. A Ewing sarcoma may be responsible for an intussusception.