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Intussusception in a 51-year-old male
  1. R Persiani1,
  2. A Biondi1,
  3. L Luigi2,
  4. A Grieco3,
  5. S Rausei1,
  6. D D’Ugo1
  1. 1
    General Surgery Unit, Department of Surgery, Catholic University, Rome, Italy
  2. 2
    Department of Pathology, Catholic University, Rome, Italy
  3. 3
    Department of Internal Medicine, Catholic University, Rome, Italy
  1. Dr Alberto Biondi, General Surgery Unit, Department of Surgery, Catholic University of Rome, Largo A. Gemelli 8, 00167 Rome, Italy; biondi.alberto{at}tiscali.it

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Clinical presentation

A 51-year-old man with a 3-month history of watery diarrhoea, marked weight loss and recurrent abdominal pain was admitted to the emergency department with severe abdominal pain and vomiting. Laboratory investigation showed anaemia, leucocytosis and hypoalbuminaemia (1.9 g/dl, normal range 3.4–4.8 g/dl). Abdominal computed tomography scan revealed dilated small bowel loops, and multiple “target” signs, suggestive of intussusceptions (fig. 1A).

Figure 1 (A) Abdominal CT scan showing multiple “target signs”. (B) Intraoperative appearance of the intussusceptions. (C) Resected jejunum and ileum showing multiple polypoid lesions. (D) A section of polypoid lesion showing dense lymphoid infiltrate with large lymphoid cells (haematoxylin and eosin, ×400).

At surgical exploration multiple polypoid lesions (ranging from 1 to 5 cm in diameter) were found in all segments of the jejunum and ileum. Two of these masses acted as leading points causing irreductable intussusceptions (fig. 1B). An extended resection of the small bowel encompassing all the polypoid lesions and the intussuscepted jejunal segments was performed (fig. 1C). Histopathological findings showed villous atrophy with a dense lymphoid infiltrate in the lamina propria of the entire resected specimen; large lymphoid cells were retrieved in polypoid lesions (fig. 1D).

Question

What is the diagnosis?

See page 10.1136/gut.2006.114892a for answer.

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