Periampullary carcinoma presenting as duodenojejunal intussusception: a diagnostic and therapeutic dilemma.
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.
Madanur
Mansoor Ahmed
MA
Department of Surgical Gastroenterology, Dr. Mehta's Hospitals Pvt. Ltd., 2, McNichols Road, 3rd Lane, Chetpet, Chennai-600031, India. Mansoor73@yahoo.com
Mula
Viswanath Reddy
VR
Patel
Dave
D
Rathinaswamy
Arunachalam
A
Madanur
Ahmed Ali
AA
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