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.