Challenges in managing duodenal intussusception: A rare cause of gastric outlet obstruction in adults
Payal Kaw
, Somanath Malage, Ashish Singh, Rahul R, Nalini Kanta Gosh, Supriya Sharma, Rajneesh Kumar Singh, Ashok Kumar
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Abstract
Intussusception is a rare occurrence in adults and only 5% being adults. Ileocolic intussusception is the most common type in adults whereas duodenal intussusception (DI) is the rarest subtype due to natural retroperitoneal fixation of the duodenum. There are only a few case-reports available in the literature. Here, we aimed to present our experience of five cases with DI in adults, there operative challenges and strategies to deal with the same. Age of presentation ranged from 18-45 years, and four out of five were females. Most common presentation was partial of recurrent gastric outlet obstruction (GOO) along with weight loss. They were all diagnosed on contract-enhanced-CT scan of abdomen, and all had a lead point in form of a benign polypoidal mass arising from duodenum. Two patients were managed with local excision of polyp and retroperitoneal fixation of redundant duodenum, whereas pancreaticoduodenectomy and segmental duodenal resection was required for the other two patients. One patient was lost to follow-up without definitive treatment as was minimally symptomatic. All four operated patients had uneventful recovery post-operatively and are doing well in follow-up. DI is an infrequent occurrence and a rare etiology of GOO in adults. Most of them having benign lead point, require surgical excision of lead point with fixation of duodenum to retroperitoneum. Anatomical proximity of important structures like CBD and pancreatic duct especially at perivaterian location makes surgical resection challenging. With thorough anatomical knowledge and appropriate management, this condition can be managed well.
Keywords: Duodenal intussusception, duodenal polyps, intussusception, gastric outlet obstruction
Cite this article as: Kaw P, Malage S, Singh A, R R, Gosh NK, Sharma S, et al. Challenges in managing duodenal intussusception: A rare cause of gastric outlet obstruction in adults. Turk J Surg 2024; 40 (2): 168-173.
Externally peer-reviewed.
Concept - AS; Design - All of authors; Supervision - AS; Data Collection and/or Processing - PK, SM; Analysis and/or Interpretation - All of authors; Literature Search - PK, SM, AS; Writing Manuscript - PK, SM, AS; Critical Reviews - All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.