Austin J Surg. 2014;1(4): 1020.
Shebrain S1* and Ryan J1
1Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, USA
*Corresponding author: Shebrain S, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008
Received: July 29, 2014; Accepted: Aug 02, 2014; Published: Aug 06, 2014
A 58 year-old male presented with 3-day history of painless, intermittent, bright red rectal bleeding associated with dizziness, fatigue and dyspnea. He appears pale with soft, non-tender abdomen. Hemoglobin is 7.1gm/dL. A colonoscopy showed blood in cecum without lesion. A computed tomography (CT) scan showed the lesion (Figure1). A laparoscopic en bloc segmental small bowel resection was performed.
Figure 1 : A CT scan of the abdomen showing enteroentericintussusception of the distal small bowel.
The most common presentation of this condition is:
- Lower gastrointestinal bleeding
- Abdominal pain
- Weight loss
- Abdominal mass
Answer is (B)
Abdominal pain is the most common symptom in adult intussusception followed by vomiting and nausea or obstructive symptoms [1,2]. Other rare presentations include bleeding, abdominal masses, and diarrhea [1-4]. About 90% of cases have a lead point with the majority (70%) of these in the small bowel such as sub mucosal lipoma, polyp, and intussuscepting Meckel diverticulum [2,3]. This patient has intramuscular small bowel lipoma with mucosal ulceration (Figure 2).
Figure 2 : Gross picture of en bloc resected segment showing an intramuscular small bowel lipoma associated with mucosal ulceration.
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