title: Periampullary carcinoma presenting as duodenojejunal intussusception: a diagnostic and therapeutic dilemma.
abstract: BACKGROUND
  An intussusception is the invagination of one segment of the intestine into another. It is more common in children, but a rare clinical entity in adults, where the condition is almost always caused by tumors.
  
  
  METHODS
  A 51-year-old female presented with symptoms of gastric outlet obstruction associated with significant weight loss, but no jaundice. Routine hematological and biochemical investigation, including tumor markers, were normal. Abdominal ultrasound revealed duodenojejunal intussusception, and subsequent CT of the abdomen confirmed it.
  
  
  RESULTS
  She underwent a laparotomy, which confirmed duodenojejunal intussusception. On reducing the intussusception and performing a duodenotomy, a periampullary mass was confirmed. Hence, she underwent a pylorus-preserving pancreaticoduodenectomy. Histology confirmed periampullary adenocarcinoma.
  
  
  CONCLUSIONS
  Adult intussusceptions are mostly caused by tumors. Contrast CT is the investigation of choice, although ultrasound can be used. One should have a low threshold for suspecting malignancy, obtain frozen section histology, and seek appropriate help at an early stage.
authors.affiliation: Department of Surgical Gastroenterology, Dr. Mehta's Hospitals Pvt. Ltd., 2, McNichols Road, 3rd Lane, Chetpet, Chennai-600031, India. Mansoor73@yahoo.com
authors.forename: Mansoor Ahmed
authors.initials: MA
authors.lastname: Madanur
authors.forename: Viswanath Reddy
authors.initials: VR
authors.lastname: Mula
authors.forename: Dave
authors.initials: D
authors.lastname: Patel
authors.forename: Arunachalam
authors.initials: A
authors.lastname: Rathinaswamy
authors.forename: Ahmed Ali
authors.initials: AA
authors.lastname: Madanur
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery*; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D001706:Biopsy; D004386:Duodenum; D005260:Female; D017219:Gastric Outlet Obstruction / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007443:Intussusception / Q000175:diagnosis* / Q000601:surgery*; D007583:Jejunum; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography