Rare cause of intussusception in a young male with a new possible etiology - A case report.

INTRODUCTION: Inflammatory Fibroid Polyp (IFP) is a rare benign tumor of the gastrointestinal tract with no proven etiology. IFPs may sometimes produce complications like intussusception when present in the small bowel. This is a case report of a patient with an established diagnosis of inflammatory fibroid polyp with abdominal tuberculosis. Such co-existence has not been reported yet in literature. CASE PRESENTATION: In this case report we see a 22-year-old gentleman presenting with a 10-day history of generalized abdominal pain which then progressed to obstipation. X-ray abdomen findings were consistent with small bowel obstruction. Computerized tomography imaging revealed the presence of a Jejuno-ileal intussusception. The patient was taken up for emergency laparotomy and he underwent resection of the intussuscepted segment with a polyp found as the lead point accompanied by dense bowel adhesions. Histopathological examination revealed it to be a Benign Fibro epithelial Polyp. Histopathology of the resected bowel segment and mesenteric lymph node also revealed findings confirmatory of abdominal tuberculosis. This may be a possible new etiology of the fibro epithelial polyp and this co-existence has never been reported before in literature. CONCLUSION: Tuberculosis may be a possible inciting factor for the development of benign fibro epithelial polyp in the small bowel which may in turn lead to complications such as small bowel intussusception warranting need for surgical intervention.

Malignant Peripheral Nerve Sheath Tumour of Small Intestine Presenting as Ileo-Ileal Intussusception - A Rare Tumour with Unusual Complication.

Malignant Peripheral Nerve Sheath Tumours (MPNST) arises from a peripheral nerve or exhibit nerve sheath differentiation on histology. Proximal portions of the upper and lower extremities and the trunk are the most common sites of occurrence. Around 50% are associated with Neurofibromatosis Type 1 (NF1) with incidence of two to five per cent in patients with NF1. The estimated incidence in general population without NF1 is 0.0001% of which gastrointestinal MPNST are extremely rare. A 45-year-old lady without pathological antecedent for NF1 was admitted with pain in right lower abdomen and multiple episodes of vomiting for 3 months. Preoperatively intussusception was diagnosed in the small bowel with USG and CECT abdomen showing characteristic target sign. On laparotomy Ileo-ileal intussusception (proximal ileum telescoping into distal ileum) was found 2 feet proximal to ileo-caecal junction with surrounding inflammed mesentery and presence of intraluminal tumour as lead point. Resection of involved segment of ileum along with its mesentery was done followed by ileo-ileal anastomosis. Histopathology was suggestive of high grade MPNST. Postoperative course and follow up for last 10 month is uneventful. This case is unique in terms of a rare tumour presenting with unusual complication and only one case had been reported so far in western literature.

Non-functional paraganglioma of retroperitoneum mimicking pancreatic mass with concurrent urinary bladder paraganglioma: an extremely rare entity.

Paragangliomas are extra-adrenal tumours of the autonomic nervous system, which rarely present as primary retroperitoneal mass mimicking pancreatic malignancy (incidence 2-8 per million populations). Urinary Bladder Paraganglioma are also extremely rare (0.06% of all Bladder Tumour and 6% of Paragangliomas) with most being malignant and high grade tumours. Non-functional varieties of both tumours are usually incidentally diagnosed. The possibility for malignant transformation in them makes surgical excision the treatment of choice. A 45-year-old lady with abdominal pain was investigated to have a complex retroperitoneal mass behind head of pancreas and a urinary bladder mass. Complete excision of retroperitoneal and bladder lesion was done. Histopathological examinations of both specimens were suggestive of Paraganglioma with no abnormal mitotic activity and capsular/vascular invasion. Although concurrent non functional paragangliomas had been reported but the synchronous non-functional paragangliomas of retroperitoneum and urinary bladder reported in this case is extremely rare and is not reported so far in English literature.