Teaching Case

Intestinal occlusion in the course of a chronic lympoid leukemia.

59 years old patient treated in our institution for a chronic lymphoid leukemia,presenting an occlusive syndrome with abdominal distension, rectal bleeding and vominting.

Three different types of intussuception can be described ; ileoileal, colocolic and ileocolic, this latter form being the most frequent. Idiopathic intussuception is a frequent cause of intestinal obstruction in young children In contrast to children, intussuception is an unusual cause of an abdominal emergency in adults where an organic cause is always identified.Tumors,lymphomas, lymphoid hyperplasia of the colon, Meckel's diverticulum, enteric cyst and Henoch's purpura are the most common organic causes. Intussuception as a complication of chronic lymphoid leukemia is very rare and only one case has been reported so far. It is considered that lymphocytic cell infiltration into the small intestine and colon could produce intestinal wall thickening and polypoid lesions and could create favorable conditions for intussuception. This is the second reported case of ileocolic intussuception during the course of leukemia in adults. In the present case, the clinical diagnosis of obstruction was based on the clinical symptoms ; abdominal distension, pain and womiting. The plain abdominal X- ray revealed nonspecific signs of bowel obstruction; distension of the intestinal loops and hydroaeric levels. Ultrasonography, which is the best technique for the diagnosis of invagination in children (revealing pathognomonic “target” and “pseudokidney” images) was not performed because of the abdominal distension. The CT scan of the abdomen was the best technique for the diagnosis confirming the intestinal obstruction and revealing the ileocolic invagination mass. The absence of intraabdomial lymph node enlargment excluded the differential diagnosis of intussuception of tumoral origin. The surgical resection of the invaginated intestinal segments confirmed the lymphoid infiltration of the mucosa and submucosa.