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J Gastrointest Surg (2011) 15:16541657 DOI 10.1007/s11605-011-1544-4
GI IMAGE
Voluminous Intussusception Involving the Whole Midgut in a Teenager: A Unique Differentiationfrom Abdominal Cocoon
Lulu Li & Shucheng Zhang
Received: 26 March 2011 /Accepted: 5 April 2011 /Published online: 22 April 2011 # 2011 The Society for Surgery of the Alimentary Tract
AbstractIntroduction Intussusception is one of the most frequent complications of PeutzJeghers syndrome which has been well described before.
Case Report Herein, a voluminous intussusception with almost the whole midgut involved in a 13-year-old girl is reported, the radiological presentation was so similar with that of abdominal cocoon that she was initially misdiagnosed accordingly. After the laparotomy confirmation, a careful review was taken on the patients CT images, a few clues for differentiation were found but proved obscure and an overriding premise for identification is just to take the diagnosis of intussusception into consideration.
Conclusion Based mainly on our experience, clinicians should be aware of voluminous intussusception as a unique differentiation of abdominal cocoon and consider it in each case of voluminous abdominal mass.
Keywords Intussusception . PeutzJeghers syndrome .
Abdominal cocoon . Radiology
Case Report
A 13-year-old girl was admitted in hospital for intermittent abdominal pain for 2 weeks with a sudden exacerbation for 1 day. The abdominal pain was predominantly at the left epigastric region, as well as an intermittent vomiting of gastric content, less stools without blood and abdominal distension were also obtained. Upon physical examination, hyperpigmented macules were seen on her lips. The abdomen was soft; a voluminous and tender mass was palpated on the upper abdomen without rebound tenderness and muscle tension. The girl had no hernias, and no ascites
or organomegaly. All laboratory blood analyses, including blood routine, liver and kidney function, were within normal limits. Both ultrasonography and computed tomography (CT) scan of the abdomen revealed a giant mass filling almost the whole upper abdomen, in description, the boundary was a thick, fibrotic, cocoon-like membrane which can be enhanced on the contrast-enhanced CT scanning, and the embedded were the intestinal loops with a little fluid surrounded. Additionally, in some scans, the intestinal dilation was also observed (Fig. 1a, b, c and d). From the radiological findings, the primary diagnosis of abdominal cocoon and incomplete intestinal obstruction was...