Hameed Tariq, Singh Mohak, Nizam Adiba, Bhatia Rahul, Sawant Gaurish
Department of Surgery, Maulana Azad Medical College, New Delhi, India.
Am J Case Rep. 2020 Feb 27;21:e920438. doi: 10.12659/AJCR.920438.
BACKGROUND Intussusception is not very common in adults, and acute intestinal obstruction with intussusception due to inflammatory myofibroblastic tumor (IMT) is extremely rare. IMT is an uncommon lesion and has no single defined cause. It predominantly affects the pediatric age group and commonly involves the lungs. Here we present a case of IMT causing ileocolic intussusception leading to acute intestinal obstruction in an adult. CASE REPORT A 40-year-old female came to the emergency department with severe colicky pain in her abdomen, and reported 6 to 7 episodes of vomiting with bilious contents, along with an inability to pass feces and flatus for 3 days. An x-ray of her abdomen in erect posture revealed multiple air-fluid levels. Because she had a previous history of tuberculosis, a possible tubercular stricture as the cause of her acute obstruction was considered; an exploratory laparotomy was performed showing her bowel loops were dilated with ileocolic intussusception. The lead point of intussusception (a well-defined 4×4×3.5 cm solid mass), was found at 15 cm proximal to the ileocecal junction. A right hemicolectomy with ileo-transverse anastomosis was performed. The histopathological examination confirmed the presence of IMT. CONCLUSIONS IMT causing ileocolic intussusception with acute intestinal obstruction is an extremely rare presentation of an uncommon entity in adults. High index of suspicion, and appropriate investigations (x-ray abdomen, ultrasound, computed tomography, and colonoscopy) depending on presentation and clinical condition of the patient can result in prompt diagnosis and early management.
肠套叠在成人中并不常见，由炎性肌纤维母细胞瘤（IMT）引起的伴有肠套叠的急性肠梗阻极为罕见。IMT是一种罕见病变，病因尚不明确。它主要影响儿童年龄组，常见于肺部。本文报告一例IMT导致成人回结肠套叠并引起急性肠梗阻的病例。病例报告：一名40岁女性因腹部剧烈绞痛前来急诊科就诊，报告有6至7次呕吐，呕吐物含胆汁，且3天未排便排气。立位腹部X线检查显示多个气液平面。由于她既往有结核病病史，考虑可能是结核性狭窄导致急性梗阻；遂行剖腹探查术，结果显示肠袢扩张，存在回结肠套叠。套叠的起始点（一个边界清晰的4×4×3.5 cm实性肿块）位于回盲部近端15 cm处。行右半结肠切除术及回肠 - 横结肠吻合术。组织病理学检查确诊为IMT。结论：IMT导致回结肠套叠并急性肠梗阻是成人中一种罕见病变的极其罕见表现。高度的怀疑指数以及根据患者的表现和临床状况进行适当的检查（腹部X线、超声、计算机断层扫描和结肠镜检查）可实现快速诊断和早期治疗。
