PMC6626877_01
Preoperative imaging. Panel A: antero-posterior abdominal X-ray in decubitus position Panel B: antero-posterior abdominal X-ray in standing position; Panel C: abdominal ultrasound with the arrow pointing at the intussusception.
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An abdominal radiograph (Fig. 1, panels A and B) showed numerous dilated loops of small bowel with multiple air-fluid levels on the upright view consistent with a high-grade small bowel obstruction. An ultrasound (Fig. 1, panels C and D) confirmed a small bowel-small bowel intussusception in the left abdomen extending over a length of approximately 7 cm with a likely pathologic lead point described as a cystic structure measuring 3 cm, possibly an enteric duplication cyst or necrotic polyp.
Picture from surgery. Panel A and B: manual reduction of small bowel-small bowel intussusception; panel C: cystic structure arising from the ileal wall; panel d: end-to-end ileo-ileal anastomosis after segmental resection.
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We resected the segment of small bowel including the lead point lesion and then performed a end-to-end ileo-ileal anastomosis (Fig. 2).
Pictures of the pathology specimen. Panel A: raised mucosal nodule; panel B: submucosal multi-loculated cyst on the cut surface; panel C: multi-cystic submucosal lesion.
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Pathology revealed a 5.2 cm long segment of small intestine with a 2.8 x 2.5 x 1.1 cm raised mucosal nodule (Fig. 3, Panel a). The mucosa overlying the nodule was granular red-brown and sectioning revealed a submucosal multi-loculated cyst on the cut surface (Fig. 3, panel b). Microscopy showed a complex circumscribed but not encapsulated multi-cystic submucosal lesion with localized deficiency of the muscularis propria. (Fig. 3, panel c).