The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Enteroenteric Intussusception A
B
A
previously healthy 52-year-old man with epigastric pain and Paul Burgers, M.D. nausea was transferred to our hospital after computed tomography (CT) of Imro Dawson, M.D., Ph.D. the abdomen revealed findings suggestive of enteroenteric intussusception. IJsselland Ziekenhuis He was treated successfully with conservative therapy. Three days after his dis- Capelle aan den IJssel, the Netherlands charge, while awaiting the results of further diagnostic studies, he presented with [email protected] similar symptoms. On physical examination, he appeared to be moderately ill, with diffuse abdominal discomfort; there were no clinical signs of peritonitis. All laboratory tests were unrevealing. CT of the abdomen, which was performed on readmission, showed dilated small-bowel loops and a “target sign” (Panel A, arrow), findings characteristic of intussusception, without evidence of a lead point. A laparotomy was performed, and the findings confirmed the suspected diagnosis of jejunojejunal intussusception. There was ischemic discoloration of the small bowel, and an intraluminal tumor was felt at the lead point of the intussusception (Panel B, arrow). A 15-cm segment of the proximal jejunum was resected, and a side-to-side anastomosis was performed. Pathological examination of the specimen revealed a 5.5-cm T2N0 adenocarcinoma, with clear resection margins. The postoperative course was unremarkable, and the patient was doing well at an 8-month follow-up visit.
DOI: 10.1056/NEJMicm1313388 Copyright © 2014 Massachusetts Medical Society.
n engl j med 371;23
nejm.org
december 4, 2014
The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF VIRGINIA on December 13, 2014. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
2217
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Enteroenteric Intussusception A
B
A
previously healthy 52-year-old man with epigastric pain and Paul Burgers, M.D. nausea was transferred to our hospital after computed tomography (CT) of Imro Dawson, M.D., Ph.D. the abdomen revealed findings suggestive of enteroenteric intussusception. IJsselland Ziekenhuis He was treated successfully with conservative therapy. Three days after his dis- Capelle aan den IJssel, the Netherlands charge, while awaiting the results of further diagnostic studies, he presented with [email protected] similar symptoms. On physical examination, he appeared to be moderately ill, with diffuse abdominal discomfort; there were no clinical signs of peritonitis. All laboratory tests were unrevealing. CT of the abdomen, which was performed on readmission, showed dilated small-bowel loops and a “target sign” (Panel A, arrow), findings characteristic of intussusception, without evidence of a lead point. A laparotomy was performed, and the findings confirmed the suspected diagnosis of jejunojejunal intussusception. There was ischemic discoloration of the small bowel, and an intraluminal tumor was felt at the lead point of the intussusception (Panel B, arrow). A 15-cm segment of the proximal jejunum was resected, and a side-to-side anastomosis was performed. Pathological examination of the specimen revealed a 5.5-cm T2N0 adenocarcinoma, with clear resection margins. The postoperative course was unremarkable, and the patient was doing well at an 8-month follow-up visit.
DOI: 10.1056/NEJMicm1313388 Copyright © 2014 Massachusetts Medical Society.
n engl j med 371;23
nejm.org
december 4, 2014
The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF VIRGINIA on December 13, 2014. For personal use only. No other uses without permission. Copyright © 2014 Massachusetts Medical Society. All rights reserved.
2217
