1. Retrograde Duodenoduodenal Intussusception: An Uncommon Complication of Peptic Ulcer
- Author
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Ayşe Kefeli, Sebahat Basyigit, Abdullah Özgür Yeniova, Bora Aktaş, and Metin Uzman
- Subjects
medicine.medical_specialty ,Gastrointestinal bleeding ,business.industry ,lcsh:R ,Invagination ,lcsh:Medicine ,General Medicine ,Abdominal distension ,medicine.disease ,Epigastric pain ,Abdominal mass ,Surgery ,medicine.anatomical_structure ,Duodenal bulb ,Correspondence ,medicine ,Duodenum ,Abdomen ,medicine.symptom ,business - Abstract
To the Editor: A 58-year-old man was presented with the complaints of epigastric pain, nonbilious vomiting, and progressive distension of the abdomen for the last 1 month. There was no significant history. Physical examination was within normal limit except abdominal distension with hyperactive peristalsis. Laboratory examinations were normal except blood urea nitrogen: 35 mg/dl, creatinine: 1.45 mg/dl, hemoglobin: 10.5 g/dl, and leukocyte counts: 17,000/mm3. Ultrasonography showed gastric distension and a 12 mm in size, lobulated wall thickening in the gastric outlet. Upper gastrointestinal endoscopy revealed dilated stomach with food residue, gaping pylorus with hyperemic mucosa, and a 15 mm in size ulcered lesion protruding into the lumen of the duodenal bulb [Figure 1]. The endoscope could not be achieved in the second part of the duodenum. Body and antral biopsies were performed endoscopically by specialized gastrointestinal pathologists for Helicobacter pylori (H. pylori). Abdominal magnetic resonance imaging showed enlarged stomach and “target sign” in the right upper quadrant of the abdomen convenient with the duodenoduodenal intussusception without definite cause for the intussusception [Figure 2]. High-dose proton pump inhibitor (pantoprazole 40 mg b.i.d.) was given to the patient. Eradication therapy was initiated for H. pylori after the reporting of histological examination. Figure 1 In the left picture, a 15 mm in size ulcered lesion protruding into the lumen of the duodenal bulb was seen in upper gastrointestinal endoscopy; in the right picture, ulcer healing and resolution of the intussusception were shown by control endoscopy. ... Figure 2 Abdominal magnetic resonance imaging showed enlarged stomach and “target sign” in the right upper quadrant of the abdomen convenient with the duodenoduodenal intussusception without definite cause for the intussusception. At follow-up, his complaints were regressed and control endoscopy showed ulcer healing and resolution of the intussusception on the sixth day of therapy [Figure 1]. Intussusception is the invagination of a segment of the intestine into another. It is rare in adults (1–5%).[1] Retrograde intussusception which is described as the invagination through the proximal direction is very uncommon accounting for only 5% of the whole cases of intussusception.[2] Clinical symptoms of duodenoduodenal intussusception include epigastric pain, abdominal mass, gastrointestinal bleeding, and enteral obstruction.[1] Mechanical factors such as adhesions, long mesentery, gastric dismotility, and sudden increase in abdominal pressure may be responsible for the etiopathogenesis of reverse intussusception. It is a well-described complication that occurs in late course after the gastrointestinal surgery.[2] In our case, adhesion secondary to inflammation may cause reverse intussusception. This is the first reported case of retrograde duodenoduodenal intussusception as a complication of duodenal ulcer. Adhesions resulting from the inflammation can lead the intussusception in our case. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
- Published
- 2015