Successful Preoperative Diagnosis of an Adult Type Intussusception owing to Ileal Malignant Lymphoma

Takashi Iwazawa, Atsushi Yasue, Toshiyuki Kanoh, Shigeo Matsui, Takeshi Tono, Yoshiaki Nakano, Hiroshi Yano, Masakatsu Kinuta, Shigeru Okamoto* and Takushi Monden

Department of Surgery, Department of Pathology*, NTT West Osaka Hospital

We report ileal malignant lymphoma causing ileocecal intussusception diagnosed before laparotomy. A 55 year-old man reporting constipation and dull lower abdominal pain from 1 month previously had moderate abdominal distension and a soft mass palpable in the right lower abdomen. USG showed a multiple concentric ring sign and hay-folk sign. CT showed a target sign with a fat component. Colonoscopy showed an incarcerated round tumor in the ascending colon diagnosed histologically on biopsy to be malignant lymphoma, necessitating ileocecal resection with regional lymph node dissection. Ileocolic intussusception was due to a tumor 60×55 mm in diameter protruding into the terminal ileum. Histopathological examination resulted in a diagnosis of non-Hodgkin lymphoma of a diffuse, large cell type, a B cell phenotype, and a tumor involving regional lymph nodes. Adult intussusception is uncommon and it does not show typical symptoms, making preoperative diagnosis difficult. In patients reporting chronic bowel obstruction, noninvasive examination such as ultrasonography or computed tomography should be done suspecting intussusception. Colonoscopy allows direct observation of the intussusception and assessment of the nature of the mass, and biopsy facilitates definitive diagnosis in some cases.

Key words
intussusception, malignant lymphoma, colonoscopy

Reprint requests
Takashi Iwazawa Department of Surgery, NTT West Osaka Hospital
2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922 JAPAN

Accepted
February 25, 2004

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