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Gastric Adenocarcinoma Presenting as Gastroduodenal Intussusception and Acute Pancreatitis

Lina El Bejjani, George Hasbany, Richard Assaker, Gregory Nicolas, Karim N. Daher, Elliott Koury, Bassel Abou Zeid, Kamal Tarabine, Elie R. Zaghrini, Monzer Danawi, Tamina Elias-Rizk, Riad Azar

(Department of Radiology, LAUMCRH, Beirut, Lebanon)

Med Sci Case Rep 2018; 5:21-26

DOI: 10.12659/MSCR.908778


BACKGROUND: Gastroduodenal intussusception by definition is the bulging of the gastric mucosa into the duodenum. This phenomenon is caused by a lead point that could include very rarely a superficial invasive adenocarcinoma in the background of a tubular adenoma. One of the complications of a gastroduodenal intussusception is the obstruction of the ampulla of Vater, causing acute pancreatitis.
CASE REPORT: In this case report, we describe the case of an 84-year-old woman who presented for a 2-day history of abdominal pain and vomiting, and was found to have elevated liver function tests along with elevated amylase and lipase in keeping with the diagnosis of an acute pancreatitis. This was followed by a CT scan that showed a gastroduodenal intussusception with a lead point located in the duodenum. The patient subsequently underwent partial lateral gastrectomy, and a pathology exam found that the lead point of the intussusception was a focal superficially invasive antral adenocarcinoma on a background of tubular adenoma that obstructed the ampulla of Vater.
CONCLUSIONS: What is particular of this case is that the lead point of the intussusception that resulted in the acute event of pancreatitis pathology was an invasive adenocarcinoma in the background of a tubular adenoma in the antrum of the stomach.

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