Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2016; 22(19): 4781-4785
Published online May 21, 2016. doi: 10.3748/wjg.v22.i19.4781
Successful management of adult lymphoma-associated intussusception by laparoscopic reduction and appendectomy
Ta-Wei Yang, Yen-Yue Lin, Yi-Wei Tsuei, Yen-Lin Chen, Cheng-Yi Huang, Sheng-Der Hsu
Ta-Wei Yang, Yen-Yue Lin, Yi-Wei Tsuei, Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Longtan 325, Taoyuan, Taiwan
Yen-Lin Chen, Department of Radiology, Taoyuan Armed Forces General Hospital, Longtan 325, Taoyuan, Taiwan
Cheng-Yi Huang, Department of Pathology, National Defense Medical Center, Tri-Service General Hospital, Neihu 114, Taipei, Taiwan
Sheng-Der Hsu, Department of Traumatic and General Surgery, National Defense Medical Center, Tri-Service General Hospital, Neihu 114, Taipei, Taiwan
Author contributions: Hsu SD performed the surgery and provided the conception; Huang CY helped in interpreting the pathology; Chen YL helped in image interpretation; Lin YY and Tsuei YW helped edit the manuscript; and Yang TW collected data and wrote this manuscript.
Supported by National Defense Medical Center, Tri-Service General Hospital, Neihu 114, Taipei, Taiwan.
Institutional review board statement: The document is acknowledged via the Institutional Review Board of National Defense Medical Center, Tri-Service General Hospital.
Informed consent statement: This case report is delivered for academic communication only, not for other purposes; In this case report, the images do not disclose the patient’s personal information; Consent was acquired from the patient for publication of this case report.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sheng-Der Hsu, MD, Department of Traumatic and General Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Cheng-Kung Road, Sec. 2, Neihu 114, Taipei, Taiwan. f1233j@yahoo.com.tw
Telephone: +886-2-87923311 Fax: +886-2-87927191
Received: January 20, 2016
Peer-review started: January 21, 2016
First decision: March 7, 2016
Revised: March 20, 2016
Accepted: March 30, 2016
Article in press: March 30, 2016
Published online: May 21, 2016
Processing time: 117 Days and 23.4 Hours
Abstract

Although primary gastrointestinal lymphoma is a rare malignancy, it can cause an intussusception in adults and can be a clinically challenging condition to manage. Intussusception could progress to life-threatening complications if left untreated or could delay chemotherapy if inappropriate surgical management is used. We report a 31-year-old man diagnosed with human immunodeficiency virus who was being treated with antiretroviral therapy. He presented with nausea, vomiting, poor appetite, and intermittent, cramping abdominal pain for over 1 wk. Abdominal computed tomography revealed a well-defined homogeneous mass in the mesenteric root region, together with a long segmental wall thickening in the ileum with ileocolic-type intussusception, which was suspected to be caused by a lymphoma. The intussusception was successfully laparoscopically reduced, and the tumor involvement of the appendix was confirmed by appendectomy with intraoperative frozen section. Systemic chemotherapy was immediately initiated after surgery without the need for bowel resection.

Keywords: Intussusception; Adult; Intestinal lymphoma; Appendectomy

Core tip: In general, surgical management of adult with an intussusception mandates the resection of the involved bowel segment. However, the surgical resection of an intussusception that is caused by intestinal lymphoma is controversial because the intestinal involvement is generally diffuse. Concerning the diffuse invasive characteristics of gastrointestinal lymphomas, laparoscopic reduction of intussusceptions and appendectomy with intraoperative frozen section were both performed that enabled us to intraoperatively identify the tumor involvement of the resected appendix. By avoiding bowel resection, systemic chemotherapy could be initiated early after surgery.