| Abstract|| |
We are reporting a case of intussusception of pyloric antrum into the first part of duodenum, which was dilated because of a localized ileus occurring as a sequel to acute cholecystitis. No other precipitating cause, such as a lead point, was foundon laparotomy. The intussusception yielded to manual reduction.
Keywords: Intussusception, Gall Stone Colic
|How to cite this article:|
Gupta A K, Agarwal M. Gastric intussusception secondary to gall stone colic. Indian J Radiol Imaging 2004;14:253-5
| Introduction|| |
Intussusception is the invagination of a portion of gut into the lumen of an immediately adjoining part . Gastric Intussusception is a rarely documented condition. A large number of conditions have been blamed to precipitate the event but the underlying etiology still remains obscure. We are reporting a case of gastric intussusception caused secondary to a localized ileus resulting from a gall stone colic.
| Case Report|| |
A 40 yrs male was admitted to the emergency ward with a complaint of acute pain in right hypochondrium. The pain was severe and colicky, radiating to right shoulder. Physical examination revealed a rapid pulse and fever. There was guarding and tenderness in the right upper quadrant, the bowel sounds were sluggish. Plain film of the abdomen in the AP erect view was done which showed a large radiopaque gall stone. Ultrasound scan suggested acute cholecystitis, the patient was kept on conservative treatment; antibiotics were started with I.V. Fluids.
On the second day the patient developed intermittent non-billious vomiting and distension of abdomen. Plain skiagram of the abdomen in erect posture was repeated with a Barium meal examination. In the immediate film [Figure - 1], a large barium filled stomach with gastric outlet obstruction beyond the first part of duodenum was seen. Distally converging gastrict folds were clearly visualized; the first part of duodenum was dilated which was seen filled with gas [Figure - 2]. The large gall stone was seen at its place. A 15 min. film raised a high index of suspicion of the Barium filled pyloric antrum intussuscepting into the first part of duodenum. The dilated first part of duodenum formed the intussuscepiens for the intussusceptum made by pyloric antrum [Figure - 3].
Laparotomy confirmed the findings. The intussusception relented to manual reduction and a concomitant cholecystectomy was performed. There was no other abnormality in the lumen or wall of stomach. The only plausible explanation for the lesion seems that the inflamed gall baldder produced a localized ileus of the first part of duodenum by virtue of its close anatomical location. This ileus resulted in the formation of a dilated sentinel loop which caused a disproportion between the lumen of pyloric canal and the first part of duodenum. Ongoing peristalsis higher up in the gastric fundus and body pushed the pylorus into this dilated sentinel loop precipitating gastric intussusception.
| Discussion|| |
Intussusception is the invagination of a portion of gut into the lumen of the immediately adjoining part. It has classically been described to follow a lead point which may be formed by a wide variety of gut lesions. The lesions range from a small mucosal lesion, a polyp to large tumors . More recent studies, however, indicate that intussusception may occur without a precipitating cause, a lead point being found only in 22% cases in Turner's study carried out in children older than 2 yrs. . Moreover, a large number of cases of intussusception cannot be explained by the so called "lead point" theory; intussusception occurring post laparotomy [3,4], in trauma  and in cystic fibrosis  are some such instances. The occurrence of intussusceptin in these "idiopathic" cases is sometimes explained by the disproportion between the sizes of the adjacent parts of the intestine where the narrow segment is pushed into the dilated portion by peristaltic activity. Like intestinal intussusception, a wide array of lead point have been described in gastric intussusception. Here too the intussusception of pyloric antrum into duodenum without a lead point has been elucidated. Such cases take place post gastrostomy, post laparotomy and following trauma. Disproportion between the lumen of pyloric canal and first part of duodenum seems a plausible explanation. Gastric intussusception, although presents with non-specific clinical manifestations; the patient may have a colicky abdominal pain and intermittent vomiting.
On a barium study, it presents as lumen narrowing, distally converging gastric folds, infolding and outpouching of gastric wall, gastric intussusceptum giving a filling defect and, if present, a leading tumor in the duodenum.
The mainstay of treatment remains correction of fluid and electrolytes; and a prompt surgical intervention which comprises of reduction of intussusception and surgical excision of lead point either endoscopically or through a formal laparotomy.
The prognosis is fairly good with early diagnosis and treatment.
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A K Gupta
Department of Radiodiagnosis, Maharani Lakshmi Bai Medical College, Jhansi-U.P
Source of Support: None, Conflict of Interest: None
[Figure - 1], [Figure - 2], [Figure - 3]