A very rare case of jejuno-jejunal invagination caused by epithelioid sarcoma: A case report and literature review

Abstract

Rationale: Intestinal invagination or intussusception is a rare event in adult and it is linked to a specific pathology abnormality in 70%-90% of cases often a benign lesion of jejunal wall being malignant tumors rare. Objective: We report our experience about a 71 year-old man presented to emergency with three days history of generalized abdominal pain and swelling, vomiting and partial bowel obstruction, ability to gas. Findings: A total body computed tomography (CT) scan detected one thickened ansa in the proximal jejunum, which suggested an invagination. Moreover evident gastrectasis with duodenal fluid distension was reported. The patient underwent laparoscopy that revealed a strictured area of the jejunum with a mass lesion. Owing to technical difficulties during surgery, the procedure was converted to open laparotomy, that showed jejuno-jejunal invagination caused by an intestinal tumor. Reduction was impossible and resection was performed. Histopathological examination revealed a malignant neoplasm with the features of mesenchymal tumor. Malignant cells with pleomorphic and large vesicular nuclei, prominent nucleoli and ample of eosinophilic cytoplasm were described. Histochemical markers supported the diagnosis of epithelioid sarcoma. One month after surgery, TC scan was performed finding lung and liver metastases also confirmed at PET scan, therefore the patient received adriamycin chemotherapy without efficacy confirming poor prognosis of this tumor. Conclusion: Being intussusceptions in adult a infrequent condition underlyning neoplastic cause should always ruled out.