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