Abstract | April 5, 2022

A rare case of adult ileo-ileal intussusception secondary to small bowel squamous cell carcinoma treated by exploratory laparotomy and small bowel resection

Presenting Author: Emana Sheikh, Medical Student, 3rd Year, Nova Southeastern University, Davie, FL

Coauthors: Emana Sheikh, OMS-3, NSU-KPCOM, FTL, FL; Shakira Payne-Blackman MD, Chief of Pathology and Laboratory Medicine, VAMC WPB, FL; Jeannette M. Perry, MS, PA (ASCP), VAMC WPB, FL; James J. Stone MD, Attending General Surgeon, VAMC WPB, FL

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to identify key diagnostic features and treat rare cases of intussusception in adult patients. It is often difficult to manage patients presenting with vague and non-specific clinical features, which may delay diagnosis and management. Thus, this article augments current literature and serves as an additional supplement for practitioners to reference for similarly time-sensitive cases. Furthermore, the lecture motivates collaboration in order to create individualized and appropriate plans for patients during emergent events indicating surgical management and maintain effective care, post-operatively.

Introduction: Ileo-ileal intussusception in an adult is a rare event, and even more uncommon is ileo-ileal intussusception secondary to squamous cell carcinoma (SCC) of small bowel.

Case Presentation: We report a case of a 67-year-old veteran male, with a history of invasive laryngeal SCC status post-total laryngectomy, who presented to the emergency department with complaint of increasing abdominal pain, nausea, and anorexia. Abdominal Computed Tomography (CT) scan with contrast confirmed small bowel obstruction (SBO), revealing intussusception and a thick-walled, edematous small bowel loop. Additionally, whirlpool sign of mesenteric vessels in the right lower quadrant on CT scan implicates possible concomitant volvulus. The patient was taken into operating room due to concern for SBO, which was successfully treated by emergent exploratory laparotomy. At laparotomy, the site of obstruction was located by clear transition from dilated bowel to decompressed bowel with a corresponding mass consistent with non-reducible intussusception. The resected ileal specimen containing the mass was then sent for histopathological examination. Pathological evaluation revealed focally ulcerated mucosa adherent to the mass, and hemorrhagic debris upon opening. The surface of the mass coursed through mucosal wall and focally into mesentery. Histological evaluation revealed SCC, indicated by immunohistochemistry staining positive for p63.

Diagnosis: Given the patient’s underlying history of invasive laryngeal SCC, it is possible that the patient’s rare ileo-ileal intussusception due to small bowel SCC was a metastatic phenomenon.

Outcome: This article augments current literature on rare cases of adult intussusception, discusses key clinical features and steps taken to diagnose and treat acute events, and reviews literature of metastatic SCC to small bowel. Abdominal CT scan is the most sensitive diagnostic modality, surgery is the most definitive treatment, and histopathological follow-up is pertinent for cases where malignancy is highly suspected. As a result, increased literary availability can better guide practitioners in assessing patient health status and accordingly create appropriate management plans for patients presenting with similarly rare yet emergent events.

References and Resources:

  1. Bekdache O, Al Nuaimi L, El Salhat H, Sharma V, Nowrasteh G, Al Rawi SJ. Uncommon metastasis of laryngeal cancer to small bowel causing intestinal obstruction treated by laparoscopic approach. Case Rep Surg. 2014;2014:260631. doi: 10.1155/2014/260631. Epub 2014 Sep 1. PMID: 25254135; PMCID: PMC4165736.
  2. Dwivedi RC, Kazi R, Agrawal N, Chisholm E, St Rose S, Elmiyeh B, Rennie C, Pepper C, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ, Nutting CM. Comprehensive review of small bowel metastasis from head and neck squamous cell carcinoma. Oral Oncol. 2010 May;46(5):330-5. doi: 10.1016/j.oraloncology.2010.01.013. Epub 2010 Feb 26. PMID: 20189444.
  3. Marinis A, Yiallourou A, Samanides L, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15(4):407-411. doi:10.3748/wjg.15.407
  4. Mumtaz S, Ahmad Z, Fatima S, Qureshi A. Squamous cell carcinoma in the small intestine. BMJ Case Rep. 2011;2011:bcr0120113762. Published 2011 May 12. doi:10.1136/bcr.01.2011.3762
  5. Raghav C. Dwivedi, Rehan Kazi, Nishant Agrawal, Edward Chisholm, Suzanne St. Rose, Behrad Elmiyeh, Catherine Rennie, Christopher Pepper, Peter M. Clarke, Cyrus J. Kerawala, Peter H. Rhys-Evans, Kevin J. Harrington, Christopher M. Nutting, Comprehensive review of small bowel metastasis from head and neck squamous cell carcinoma, Oral Oncology, Volume 46, Issue 5, 2010, Pages 330-335, ISSN 1368- 8375, https://doi.org/10.1016/j.oraloncology.2010.01.013.
Posted in: Surgery & Surgical Specialties35