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Gut. 2007 November; 56(11): 1556.
PMCID: PMC2095657

EDITOR'S QUIZ: GI SNAPSHOT

Answer

From question on page 1528

The answer is gastroduodenal intussusception as a result of a solitary gastric carcinoid.

Since the condition could not be resolved following endoscopy or contrast barium, the patient underwent surgery immediately following these procedures. During surgery, gastroduodenal intussusception was evident. Following reduction of the intussusception, a subtotal gastrectomy and a lymph node dissection were performed. Microscopy of the gastric tumour showed a submucosal tumour in an organoid or trabecular arrangement, composed of uniform oval cells (fig 11).). Immunohistochemical staining with neuron‐specific enolose, chromogranin and P53 oncoprotein revealed positive findings (fig 22).). The lymph node revealed metastatic tumours.

figure gt106559a.f1
Figure 1 Microscopy of the gastric tumour showed an organoid or trabecular arrangement, composed of uniform oval cells (H&E, ×400).
figure gt106559a.f2
Figure 2 Immunohistochemical staining with chromogranin demonstrated positive findings.

Gastroduodenal intussusception is an extremely rare condition that is usually caused by the prolapse of a gastric tumour into the duodenum with subsequent invagination of a portion of the stomach wall. A number of causes of intussusception have previously been reported including malignant gastric tumours such as adenocarcinoma, leimyosarcoma and gastrointestinal stromel tumour, and benign gastric tumours such as leimyoma, lipoma, adenoma, inflammatory fibrinoid polyps and gastric heterotopia. To the best of our knowledge, the present report is the first to describe gastroduodenal intussusception as a result of a solitary gastric carcinoid. The signs and symptoms of this condition include abdominal pain, obstruction and upper gastrointestinal bleeding. Herein, the patient presented with upper gastrointestinal bleeding. The majority of previous reports have suggested that an abdominal CT scan can provide the most accurate diagnostic rate of intestinal intussusception; however, based on our experience, we believe that contrast studies and endoscopy are useful tools for the diagnosis of gastroduodenal intussusception.


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