TTP5.13 Gastro-gastric intussusception: A rare presentation of malignant gastric polyp

Aims Intussusception is a rare presentation amongst adults, especially in the foregut territory. Over 90 % of such cases in adulthood involve an anatomical abnormality, with surgery being the typical treatment. Methods We present a case report of gastro-gastric intussusception secondary to a malignant gastric polyp, alongside its surgical management technique. Results A 91-year-old man with no previous surgical history presented with one day of profuse vomiting and epigastric pain. He was hemodynamically stable with a non-tender abdomen. Blood tests showed raised white cell counts and stage one acute kidney injury. His abdominal computed tomography scan demonstrated distended oesophagus and distal gastro-gastric intussusception secondary to a large gastric polypoidal lesion. Oesophago-gastro-duodenoscopy (OGD) revealed an irreducible large antral polyp obstructing the gastric outlet. Exploratory laparoscopy was performed and a similarly unsuccessful reduction led to laparoscopic gastrotomy. A 5x 4cm gastric antrum polyp was found to have completely telescoped beyond and obstructing the pylorus. Trans-gastric resection of the polyp was performed with laparoscopic Echelon™ stapler, with closure of gastrotomy also performed laparoscopically. Enteral feeding was commenced on post operative day (POD) 5 and the patient was discharged on POD 8. Histology analysis concluded the polyp as a pT1b intestinal type tubular adenocarcinoma, with clear resection margins. The patient remained well on his one month post operative follow up. Surveillance for recurrence was recommended over gastrectomy due to advance age. Conclusions Gastro-gastric intussusception is an exceptionally rare foregut condition, often presenting with atypical symptoms. Hence, management should be tailored individually to each patient.