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Radiological Case of the Month
Miguel Iuchtman, MD;
Doron Zamir, MD;
Tzvi Bartal, MD;
Uri Soimu, MD
From the Departments of Pediatric Surgery (Dr Iuchtman), Internal Medicine (Dr Zamir), and Diagnostic Radiology (Drs Bartal and Soimu), Hillel Yaffe Medical Center, Hadera, Israel, and Rappaport Faculty of Medicine, Haifa, Israel.
Arch Pediatr Adolesc Med. 1999;153:763-764.
A 15-YEAR-OLD boy had recurrent colicky lower abdominal pain sometimes accompanied by nonbloody diarrhea. The episodes of pain lasted from hours to several days. His temperature was always normal and he did not vomit. During the last 2 years the patient had gained neither weight nor height. Physical examination revealed lower abdominal tenderness. Results of flexible sigmoidoscopy and biopsy were normal. Computed tomography of the abdomen showed a large lesion in the cecocolic area (Figure 1 and Figure 2). Enteroclysis supported the diagnosis of a large mass in the cecum and ascending colon (Figure 3). At colonoscopy the mass was visualized (Figure 4).
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Figure 1.
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Figure 2.
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Figure 3.
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Figure 4.
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Denouement and Discussion: Intermittent Ileocolic Intussusception Caused by an Unusual Choristoma
Figure 1. Computed tomographic scan showed a hyperdense mass occupying the cecum area.
Figure 2. Arrow points to target sign suggesting intussusception.
Figure 3. The cecal filling defect seen at enteroclysis.
Figure 4. Endoscopic view of polypoid cecal lesion that extends into the ascending colon.
Figure 5. Operative specimen showing resected ileal segment.
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Figure 5.
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Figure 6. Opened specimen shows polypoid lesion with its long pedicule.
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Figure 6.
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Figure 7. Gastric heterotopic mucosa and foci of pancreatic tissue.
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Figure 7.
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At laparotomy an ileocecolic intussusception was reduced and the ileal segment containing a tumor was resected (Figure 5). The lead point was a large pedunculated polyp (Figure 6). Histologic examination showed that the polyp consisted mainly of heterotopic gastric antral and fundic mucosa and foci of pancreatic tissue (Figure 7).
The term choristoma is applied to normal tissue in an abnormal location. Heterotopic gastric mucosa occurs anywhere in the gastrointestinal tract.1-2 Heterotopic gastric tissue in the small intestine is rare and in most cases is associated with a congenital anomaly.3 Use of imaging and endoscopic examination allows earlier diagnosis.4-5 A lead point is frequently present in chronic or intermittent intussusception and therefore nonoperative reduction is not indicated. Surgical resection of the involved segment is the preferred treatment, because it corrects the obstruction, avoids recurrence, and excludes the possibility of an associated malignant neoplasm.6-7
AUTHOR INFORMATION
Accepted for publication March 18, 1998.
Corresponding author: Miguel Iuchtman, MD, Pediatric Surgery, Hillel Yaffe Medical Center, PO Box 169, Hadera 38100, Israel.
REFERENCES
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1. Lewin KJ, Ridell RH, Weinstein WM. Gastrointestinal Pathology and Its Clinical Implications. New York, NY: Igathe-Shoin; 1992:1171.
2. Devereaux CE, Devereaux RG. Heterotopic gastric mucosa of the rectum with a review of the literature. J Clin Gastroenterol. 1994;19:41-45.
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3. Diamond T, Russell CFJ. Meckel's diverticulum in the adult. Br J Surg. 1985;72:480-482.
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4. Bhisitkul DM, Usternick R, Shkolnic A, et al. Clinical application of ultrasonography in the diagnosis of intussusception. J Pediatr. 1992;121:182-186.
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5. Bar-Ziv J, Solomon A. Computed tomography in adult intussusception. Gastrointest Radiol. 1991;16:264-266.
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6. Azor T, Berger DL. Adult intussusception. Ann Surg. 1997;226:134-138.
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7. Lee SM, Mosenthal WT, Weismann RE. Tumorous heterotopic gastric mucosa in the small intestine. Arch Surg. 1970;100:619-621.
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SECTION EDITOR: BEVERLY P. WOOD, MD
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