A 52-year-old woman was admitted due to intermittent abdominal pain for 10 days. The pain was postprandial, periumbilical, migrating and colicky and was accompanied by occasional nausea and vomiting. She also had weight loss of 8 kg for 1 month. There was no history of pulmonary tuberculosis, hypertension or diabetes mellitus. She never smoked or drank alcohol. On admission, her body temperature was 36.4 C, the pulse 72/min and respiration 20/min. Her blood pressure was 100/70 mmHg. She had a chronically ill-looking appearance. The conjunctivae were not pale and the sclerae were not icteric. Her abdomen was flat and mildly tender on the epigastrium without rebound tenderness. Bowel sound was slightly increased. No mass or organomegaly could be noted. There was no abnormal finding on digital rectal examination.
Hemoglobin was 11.5gm/dl, hematocrit 34.2%, and WBC 9,000/mm3 (60% segmented neutrophils, 7% band neutrophils and 32% lymphocytes). Total serum bilirubin was 0.9 mg%, AST 40 IU/L, ALT 20 IU/L and albumin 3.7 gm%. Serum electrolytes, CEA and alpha fetoprotein were normal. There was no abnormal finding on the chest X-ray. The upright plain abdominal film revealed a mild ileus of the small bowel. Broad spectrum antibiotics were started and she was forced to take nothing by mouth, but no improvement was noted. On the 3rd hospital day, abdominal ultrasonogram demonstrated an echogenic lesion located in the supravesical space (Fig. 1), and abdominal CT scan disclosed a dilated small bowel loop filled with fluid and a round solid mass in the right anterior supravesical space (Fig. 2).
On the 4th hospital day, she underwent an exploratory laparotomy with an impression of small bowel obstruction by a tumor. During the operation, a jejunojejunal intussusception was noted with an intraluminal obstructing mass. The small bowel was dilated proximally and lymphadenopathy on the surrounding mesentery was noted.
Grossly, it was a well-established polypoid mass (2.3x2.1x2 cm) located perpendicular to the plane of mucosa on the edge of the mesenteric line of the jejunum (Fig. 3). The cut surface of the polyp was homogeneously pinkish-yellow with smooth glistening surface (Fig. 4). Grossly, the serosa and the mucosa of the jejunum were unremarkable. Microscopically, the lesion consisted mainly of a mass of loose connective tissue developed in the submucosa. Loose fibrous stroma infiltrated the muscularis propria, and the variably sized small vessels were observed with diffuse inflammatory infiltrates, mostly eosinophils (Fig. 5, 6). Resected mesenteric lymph nodes showed reactive hyperplasia. All these findings were well compatible with an inflammatory fibroid polyp.
The patient's postoperative course was uneventful with prompt resolution of periumbilical pain and vomiting.