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Título

SMALL BOWEL METASTASIS OF RENAL CELL CARCINOMA PRESENTING AS AN ILEO-ILEAL INTUSSUSCEPTION FOLLOWING CURATIVE NEPHRECTOMY IN AN ELDERLY PATIENT.

Descrição sucinta do(s) objetivo(s)

● To report a rare case of small bowel metastasis of renal cell carcinoma presenting as an ileo-ileal
intussusception in an elderly patient.
● To describe the most common sites of clear cell renal carcinoma recurrence and metastases sites.
● To describe the most frequent causes of intestinal intussusception in elderly patients.

História clínica

A 60 year old female patient who underwent radical left nephrectomy for clear cell renal carcinoma
(CCRC) presented to our institution with one week of abdominal pain. Contrast enhanced computed
tomography (CECT) study revealed an enhancing polypoid mass protruding into the ileal lumen with
telescoping of the proximal ileal loop giving an appearance of bowel within bowel (target sign),
consistent with and ileo-ileal intussusception. An enhancing lesion infiltrating the left psoas muscle was
also observed, making the possibility of bowel metastasis more likely. No signs of bowel obstruction
were found. Lastly, the patient underwent surgery and proved to have ileo-ileal intussusception due to an
intraluminal ileal mass, which served as the lead point. Histopathological examination confirmed the presence of CCRC in the metastatic polypoid mass.

Discussão e diagnóstico

CCRC are the most frequent and unpredictable type of renal malignancies. Nephrectomy is considered
the standard treatment, but more than one-third of all patients will develop metastases after surgery.
CCRC frequently metastasizes to the lung, liver, adrenal glands, bone and brain, but rarely metastasizes to
the small bowel.
The patient of this case presented with ileo-ileal intussusception, which rarely occurs in the elderly and is
frequently associated with neoplasms, enteric autoimmune pathologies or previous intra-abdominal
surgeries. The intraluminal ileal mass observed in the CECT, altogether with the left psoas lesion, made
the diagnosis of bowel metastasis more likely, which was lastly confirmed.

Conclusões

CCRC recurrence can occur many years after nephrectomy, and metastases to the gastrointestinal tract
(excluding the liver) accounts for about 0.2 − 0.7% of CCRC. In this case, we describe an elderly patient
with CCRC small bowel metastasis presenting as an ileo-ileal intussusception.

Palavras Chave

intussuscepção; câncer renal; intestino delgado

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