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Gut. 2007 July; 56(7): 1018.
PMCID: PMC1994346

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From question on page 967

CT demonstrated all essential features of gastroduodenal intussusception—namely (1) invagination of the pyloric part of the stomach into the duodenum, which gives a “beak” appearance (fig 1A1A);); (2) classical target sign or bull's eye appearance, which consists of concentric circles of low and high densities (fig 1B1B);); and (3) a roundish mass with fat density, which serves as a lead point (fig 1C1C).

figure gt98632a.f1
Figure 1 Endoscopy showing the duodenal submucosal lipoma and surface ulcer. The pylorus invaginated into the second part of duodenum (presence of circular folds).

Both oesophagogastroduodenoscopy (fig 2) and laparoscopy confirmed the presence of gastroduodenal intussusception, which was reduced by both endoscopic gas insufflation and laparoscopic manipulation. The duodenal tumour was resected through a longitudinal gastroduodenostomy and was confirmed histologically to be submucosal lipoma.

Intussusception is most frequently seen in children. Adult cases are invariably associated with a lead point, which can be a benign or malignant tumour. The most common site of intussusception is either the small or large bowel. Gastroduodenal intussusception due to duodenal lipoma is extremely rare and may present as gastric outlet obstruction and occult blood loss due to formation of surface ulcers.


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