title: A case of multiple intussusceptions in the small intestine caused by metastatic renal cell carcinoma.
abstract: Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is rare. Small bowel metastasis from RCC can induce obstruction or bleeding, and perforation can also be induced in rare case. Yet RCC metastasis to the small bowel is unlikely to be a direct cause of intussusceptions. A few cases of intussusceptions caused by small intestinal metastasis of RCC have been reported, but multiple small intestinal intussusceptions are extremely rare. We report here on a 47-year-old male patient who presented to the emergency room with acute abdominal pain. He had undergone radical nephrectomy 2 years previously due to left RCC. The abdominal CT scan revealed enhanced masses with the "target" sign that suggested enteric intussusceptions in the jejunum. Eight pedunculated masses within the small intestinal lumen led to intussusceptions at 30 and 150 cm distal to Treitz ligament. Three segmental resections of the small intestine and functional end to end anastomosis were done. The patient recovered uneventfully from this operation. To the best of our knowledge, this is the 1(st) report of metastases from RCC that presented as synchronous intraluminal polypoid tumors, and these tumors served as the lead points for two intussusceptions in the jejunum.
authors.affiliation: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea. wkeo@dreamwiz.com
authors.forename: Wan Kyu
authors.initials: WK
authors.lastname: Eo
authors.forename: Gou Young
authors.initials: GY
authors.lastname: Kim
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Choi
references.citation: Br J Urol. 1991 Jun;67(6):657-8
references.pmid: 2070218
references.citation: Surg Gynecol Obstet. 1957 Aug;105(2):159-65
references.pmid: 13455391
references.citation: J Urol. 1982 Jun;127(6):1092-5
references.pmid: 7087014
references.citation: Am J Surg. 1997 Feb;173(2):88-94
references.pmid: 9074370
references.citation: Ann Surg. 1997 Aug;226(2):134-8
references.pmid: 9296505
references.citation: Surg Today. 2006;36(1):85-8
references.pmid: 16378202
references.citation: Endoscopy. 2000 Aug;32(8):658-60
references.pmid: 10935799
references.citation: JBR-BTR. 2001 Aug;84(4):153-4
references.pmid: 11688728
references.citation: Ann Surg. 1981 Feb;193(2):230-6
references.pmid: 7469558
references.citation: Aust N Z J Surg. 1981 Apr;51(2):179-80
references.pmid: 6940547
references.citation: Surgery. 1952 Dec;32(6):991-6
references.pmid: 13005328
references.citation: Br J Urol. 1986 Aug;58(4):460
references.pmid: 3756421
references.citation: Trop Gastroenterol. 2007 Jan-Mar;28(1):35-6
references.pmid: 17896609
references.citation: J Clin Oncol. 2006 Jul 1;24(19):3101-6
references.pmid: 16809736
references.citation: Radiology. 1977 Oct;125(1):29-33
references.pmid: 897183