Journal of Postgraduate Medicine
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CASE REPORT
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Year : 1991  |  Volume : 37  |  Issue : 3  |  Page : 176-8  

Ileo-caeco-colic intussusception due to extensive benign lymphoid hyperplasia of the ileo-caecal region (a case report).

RG Redkar, SS Sathe, AN Dalvi, BA Kulkarni, AN Supe, Chandrashekhar, IM Vora 
 Department of General Surgery, Seth G. S. Medical College, Parel, Bombay, Maharashtra.

Correspondence Address:
R G Redkar
Department of General Surgery, Seth G. S. Medical College, Parel, Bombay, Maharashtra.

Abstract

An unusual case of extensive benign lymphoid hyperplasia of the ileo-caecal region causing ileo-caeco-colic intussusception is presented here, with a review of relevant literature. The diagnosis of intussusception was reached with the help of an abdominal ultrasound and barium enema. Histopathology of the resected specimen, revealed lymphoid hyperplasia.



How to cite this article:
Redkar R G, Sathe S S, Dalvi A N, Kulkarni B A, Supe A N, Chandrashekhar, Vora I M. Ileo-caeco-colic intussusception due to extensive benign lymphoid hyperplasia of the ileo-caecal region (a case report). J Postgrad Med 1991;37:176-8


How to cite this URL:
Redkar R G, Sathe S S, Dalvi A N, Kulkarni B A, Supe A N, Chandrashekhar, Vora I M. Ileo-caeco-colic intussusception due to extensive benign lymphoid hyperplasia of the ileo-caecal region (a case report). J Postgrad Med [serial online] 1991 [cited 2021 Dec 7 ];37:176-8
Available from: https://www.jpgmonline.com/text.asp?1991/37/3/176/765


Full Text




  ::   IntroductionTop


Intussusceptions in adults is a rare cause of intestinal obstruction[2]. Benign lymphoid hyperplasia, known to cause intussusceptions in infancy and childhood[8], has not been reported as the cause of intussusceptions in adults as per the review of available literature. The rarity of this condition prompted us to present this case.


  ::   Case reportTop


RE, a 16-year-old male presented with fullness in the right hypochondrium for four days with colicky, periumbilical pain and bilious vomiting for one day. Except for mild fever the patient's vital parameters were stable. Per abdominal examination revealed an 8 x 3 cms, firm, mobile, tender lump in the right hypochondrium. There were no hyper peristalses. Per rectal examination was normal. A plain X-ray of the abdomen in standing position was non-contributory. With provisional diagnosis of acute cholecystitis an urgent ultrasound exanimation of the abdomen was asked for. Ultrasound examination revealed the presence of the target sign[4],[5],[7] and the bull's eye sign[4],[5],[7]. Hence a differential diagnosis of a typical intussusceptions, an appendicular mass or an amoeboma was made. With the diagnosis of intussusceptions in mind, a guarded barium enema was done which confirmed the diagnosis. Exploratory laparotomy through a right upper paramedian incision, revealed a reducible ileo-caeco-colic intussusceptions without any gangrenous affection of the bowel. The ileo-caecal regions showed a lumpish, indurated feel suggestive of a tumour or lymphoma. The entire mesentery was studded with fleshy, non-caseating lymph nodes. An ileo-caecal resection with end to end ileo-ascending anastonlosis was carried out. The patient had an uneventful recovery and was discharged on the tenth day.

Pathology :

On gross, the caecum showed an elevation of congested mucosa on the posterior wall forming a polypoid elevation about 4 X 2.5 X 1.5 cm on the ileo-caecal valve (See [Figure:1]) Microscopy revealed ulceration of the mucosa with extensive lymphoid hyperplasia forming germinal centres which were confined above muscularis mucosa (See [Figure:2]) Occasionally the lymphoid follicles were seen penetrating the submucosa which showed congested vessels and a few acute inflammatory cells. Lymph nodes showed features of chronic non-specific lymphadenitis.


  ::   DiscussionTop


Intussusceptions are quite rare in adults and comprise of only 2 5% of the total adult in testinal obstructions. The etiological factors vary over a wide spectrum ranging from benign submucous lipomata to malignant lesions of the terminal ileum. Benign lymphoid hyperplasia is a rare lesion which involves localised morphological changes of the ymphoid tissue within the intestinal mucosa and the submucosa accompanied with non-specific mesenteric lymphadenitis[3]. This condition occurs mainly in infancy and early childhood, spontaneous regression being a rule[8]. However, the hyperplastic tissue may cause partial obstruction at the ileo-caecal junction. The peristaltic activity may drag the enlarged patches and cause further irritation and oedema which itself may precipitate intussusceptions. Haemorrhage or obstructions are other known complications[6],[8]. Surgical intervention is mandatory in such complications and offers good prognosis as reported by Cornes and Dawson[1].

Intussusceptions due to lymphoid hyper-plaster in adults have not been recorded so far in the literature, our case being the first. The gross specimen showed the polypoidal lesion similar to that seen in children as reported by Swartley and Stayman[8]. The histopathology confirmed the diagnosis. Fisher and Schaefer[3] have documented 8 cases of lymphoid hyperplasia of the terminal ileum with pathological verification on resected specimens. Almost all their cases were in the paediatric age groups. Cornes and Dawson[1] have reported 9 cases of intussusception due to this pathology requiring surgical intervention. All the cases were between 4 months and 4 years of age. Swartley and Stayman[8] encountered the condition in infancy and childhood and proposed a conservative line of treatment unless complicated by obstruction, intussusceptions or bleeding.

In our case, resection of the ileo-caecal region was done for this condition and the patient was found to be well at 2 months' follow-up. This case is presented to record a possibility of benign lymphoid hyperplasia of the ileo-caecal region as being the cause of intussusceptions in adults.


  ::   AcknowledgmentTop


We thank the Dean, Seth GS Medical College and King Edward Memorial Hospital for allowing us to publish this report.

References

1 Cornes JS, Dawson IMP. Papillary lymphoid hyperplasia at the ileo-caccal valve as a cause of acute intussusceptions in infancy. Arch Dis Child 1963; 38:89-91.
2Ellis H. Special forms of intestinal obstructions. In: "Mainaot's Abdominal Operations" Vol. II. SI Schwartz, H Ellis, editor. 8th edition. Norwalk, Connecticut: Appleton Century Crofts; 1989, pp 1183-1220.
3Fieber SS, Schaefer HJ. Lymphoid hyperplasia of the terminal ileum-a clinical entity? Gastroenterology 1966; 50:83-98.
4Mittelstaedt CA. In: "Abdominal Ultrasound". Ist edition. London: Churchill Livingstone; 1987, pp 633-634.
5Morgan CL, Trought WS, Oddson TA, Clark WM, Wce RP. Ultrasound patterns of disorders affecting the gastrointestinal tract. Radiology 1980; 135:129-135.
6Morson BC, Dawson IMP. Tumours of small intestines. In: "Gastrointestinal Pathology". 1st edition. Blackwell Scientific Publications; 1972, pp 364.
7Sarti DA. In: "Diagnostic Ultrasound - Text and Cases". 2nd edition. Chicago: Year Book Medical Publishers Inc.; 1987, pp 526.
8Swartley RN, Stayman JW. Lymphoid hyperplasia of the intestinal tract requiring surgical intervention. Ann Surg 1962; 155:238-240.

 
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