Recurrent intussusception of small bowel in a young patient due to metastases from cardiac undifferentiated pleomorphic sarcoma: A first ever case report

Highlights • Metastatic undifferentiated pleomorphic sarcoma (Malignant Fibrous Histiocytoma) is a rare entity in the visceral organs. • We report a case of a metastatic primary cardiac undifferentiated pleomorphic sarcoma which presented with a recurrent small bowel intussusception in a young man. • Laparotomy by a small midline incision performed on the same day identified an intussusception of a 15-cm section of small intestine caused by a 4-cm intraluminal metastasis from undifferentiated pleomorphic sarcoma. • Metastasis intussusception in the small intestine is a very rare condition and they are part of differential diagnosis in patient with a history of tumor who present with intussusception.
Introduction Undifferentiated metastatic pleomorphic sarcoma (Malignant Fibrous Histiocytoma) is a rare entity in the small intestine, especially when the primary tumor is of cardiac origin. Case Report We report a case of metastatic intestinal undifferentiated pleomorphic sarcoma in a young patient with a history of primary cardiac tumor in the left atrium and recurrent small bowel intussusception. He was admitted for abdominal pain and constipation. A segmental resection of the small intestine was performed with side-to-side entero-enteroic anastomosis. Discussion Intussusception of the small bowel is rare in adults and it represents about 1–3% of intestinal obstructions. It mainly affects the fifth decade with a male/female ratio of 1:5 More than 60% of patients with intussusception have a tumor with 50% being malignant. This type of intussusception can be diagnosed on the CT abdominalscan. Radiological features include a typical “target” sign with overdistention of the proximal intestine and air-fluid levels, but the diagnosis of certainty is made by exploratory laparotomy. Conclusion The metastatic tumors that cause intussusception represent a rare clinical condition in adult patients, but much more common than primary ones. Metastasis to the small intestine are part of differential diagnosis in patient with a history of tumor who present with intussusception.