Advertisement

A Rare Cause of Abdominal Pain and Hematochezia

  • Arnav Sud
    Affiliations
    Rady Faculty of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    Search for articles by this author
  • Signy Holmes
    Affiliations
    Department of Radiology, Rady Faculty of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    Search for articles by this author
  • Seth R. Shaffer
    Correspondence
    Correspondence: Address correspondence to: Seth R. Shaffer, MD, MS, Assistant Professor of Medicine, Section of Gastroenterology, University of Manitoba, 804G – John Buhler Research Center, 715 McDermot Ave, Winnipeg, Manitoba R3E 3P4, Canada.
    Affiliations
    Section of Gastroenterology, Department of Internal Medicine, Rady Faculty of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
    Search for articles by this author
Open AccessPublished:May 07, 2022DOI:https://doi.org/10.1016/j.gastha.2022.04.017
      A 72-year-old female with metastatic stage 1B leiomyosarcoma was admitted to hospital due to increasing hip pain secondary to a pathological left acetabular fracture caused by a metastatic lytic lesion. The patient underwent a left cemented total hip arthroplasty and was undergoing rehabilitation postoperatively. Approximately 10 days after admission, she developed abdominal pain and hematochezia. Her hemoglobin dropped 16 points, from a baseline of 80 to 64. A colonoscopy was then performed, which revealed a tubular mass extending distally from the cecum (Figure A) to the transverse colon (Figures B and C). The mass originated from the ileocecal valve, and the terminal ileum could not be intubated. An urgent CT scan of the abdomen/pelvis was then performed, revealing an ileocolonic intussusception within the right abdomen, extending over at least 12 cm (Figure D).
      The patient underwent a right hemicolectomy the following day. Pathology of the surgically resected bowel revealed a 4.2-cm metastatic tumor deposit from her known leiomyosarcoma cancer at the tip of the intussuscepted bowel in the ileum. Focal acute ischemic changes were also seen. Postoperatively the patient was doing very well, with resolution of her abdominal pain and hematochezia.