Intussusception due to inflammatory fibroid polyp:A case report and comprehensive literature review

AIM:To give an overview of the literature on intussusception due to inflammatory fibroid polyp(IFP).METHODS:We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP,accessed via PubMed and Google Scholar databases.For the search,the keywords used were:intussusception,IFP,intussusception and IFP,intussusception due to IFP,and IFP presenting as intussusception.The search covered all articles from 1976 to November 2011.RESULTS:We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain,vomiting,and nausea.Ultrasonography demonstrated small bowel intussusception.An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy.Partial ileal resection and anastomosis were performed.A diagnosis of ileal IFP was made based on the immunohistochemical findings.In addition,a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review.The patients were aged 4 to 81 years(mean,49 ± 16.2 years);44 were women(mean,51.8 ± 14.3 years) and 41 were men(mean,46 ± 17.5 years).According to the location of the IFP,ileal intussusception was found in 63 patients,while 17 had jejunal,three had colonic,and two had ileojejunal intussusception.CONCLUSION:Although IFPs are rare and benign,surgery is the only solution in case of intestinal obstruction.Differential diagnosis should be made via immunohistochemical examination.

A rare case of langerhans cell histiocytosis of the gastrointestinal tract

Langerhans cell histiocytosis （LCH） is a group of idiopathic disorders characterized by the proliferation of specialized, bone marrow-derived langerhans cells and mature eosinophils. The clinical spectrum ranges from an acute, fulminant, disseminated disease called Letterer Siwe disease to solitary or few, indolent and chronic lesions of the bone or other organs called eosinophilic granuloma. Involvement of the gastrointestinal tract is very rare in LCH. We present the case of a 53-year-old woman referred by her primary care physician for a screening colonoscopy. A single sessile polyp, measuring 4 mm in size, was found in the rectum. Histopathological examination revealed that the lesion was relatively well circumscribed and comprised mainly a mixture of polygonal cells with moderate-to-abundant pink slightly granular cytoplasm. The nuclei within these cells had frequent grooves and were occasionally folded. Immunohistochemical staining was positive for CD la which confirmed the diagnosis of LCH. On further workup, there was no evidence of involvement of any other organ. On follow up colonoscopy one year later, there was no evidence of disease recurrence. Review of the published literature revealed that LCH presenting as solitary colonic polyp is rare. However, with the increasing rates of screening colonoscopy, more colonic polyps may be identified as LCH on histopathology. This underscores the importance of recognizing this rare condition and ensuring proper follow-up to rule out systemic disease.