Abstract
We present a case of a 36-year-old male who presented with abdominal
pain and vomiting. Inflammatory markers were elevated in routine
investigations, while other laboratory parameters were within normal
limits. Ultrasound imaging revealed a target lesion, which required
further evaluation with a CT scan and confirmed ileocolic
intussusception. An exploratory laparotomy showed a solid lesion
measuring 5 by 6 cm in the cecum, along with evidence of ileocolic
intussusception. A standard right hemicolectomy was performed, and the
postoperative course was uneventful. Histopathological examination
showed an inflammatory myofibroblastic tumor with nodular hyperplasia.
The report highlighted the importance of assessing rare neoplastic
causes in patients with intussusception.
Keywords: Inflammatory Myofibroblastic tumor, intussusception,
hemicolectomy, spindle cell proliferation, abdominal pain, vomiting
Introduction : Inflammatory Myofibroblastic tumors (IMTs) are
rare neoplasms characterized by proliferative Myofibroblastic spindle
cells accompanied by a prominent inflammatory infiltrate. [1] IMTs
predominantly affect children and young adults but can occur at any age.
[2] The most common site of occurrence is the lung, followed by the
extrapulmonary sites like liver, pancreas, intestine, and bones [3].
Intestinal involvement is relatively rare, and ileocolic intussusception
caused by IMT is an even rarer presentation [4]. We report a case of
a 36-year-old male who presented with abdominal pain, vomiting, and
subsequent diagnosis of IMT leading to ileocolic intussusception.
Case presentation: A 36-year-old male presented to the
emergency department with a three-day history of diffuse abdominal pain,
followed by vomiting. The pain started from the right lower quadrant and
later generalized. On physical examination, mild tenderness was present
on deep palpation in the right lower quadrant of the abdomen. The
patient had no significant medical history and denied any recent weight
loss or changes in bowel habits.
Laboratory investigations revealed raised inflammatory marker. A
complete blood count revealed elevated WBCs (17,100/µL) with
neutrophilia (80%). Blood urea nitrogen and creatinine level were
normal and other hematological and biochemical parameters were within
normal limits. An ultrasound examination of the abdomen showed a target
lesion in the right lower quadrant, raising the suspicion of
intussusception. A subsequent CT scan confirmed segmental,
circumferential thickening of the terminal ileocolic junction showing a
target stratification pattern (Fig 1) . The protrusion of
terminal ileum into ascending colon gave an intraluminal pseudomass
appearance (Fig 2) . The small bowel loops proximal to ileocolic
junction was dilated with outer-to-outer diameter of 3.2cm and mottled
appearance giving small bowel feces sign.