WOFAPS 2025 8th World Congress of Pediatric Surgery

Ahmed Omar Ali, Secil Yuksel, Osman Hakan Kocaman, Başak Erginel

Istanbul University Istanbul Medical Faculty Department of Pediatric Surgery

Case Report: Jejunojejunal Intussusception Caused by Intestinal Metastasis of Osteosarcoma in an Adolescent Patient

Introduction
Osteosarcoma is a high-grade malignant bone tumor affecting the long bones in adolescents and young adults. The lungs are the most common site for distant metastases. Extrapulmonary metastases are rare and typically appear late in disease progression. Small bowel metastases are exceptionally uncommon. Intussusception in adolescents is also rare and usually has a pathological lead point such as lymphoma, gastrointestinal stromal tumors, or rarely metastatic malignancies. This case highlights a rare presentation of jejunojejunal intussusception caused by metastatic osteosarcoma.

Case Presentation
A 17-year-old female presented with a 10-day history of intermittent abdominal pain, nausea, vomiting, and low-grade fever. Her medical history included a diagnosis of high-grade osteosarcoma of the left femur three years prior, treated with wide excision and adjuvant chemotherapy. She developed pulmonary metastasis 18 months after diagnosis, managed with left lower lobectomy, and a year ago, had a metastatic lesion surgically removed from the left ventricle of the heart.

On presentation, vital signs were stable; abdominal exam showed tenderness in the right lower quadrant without peritoneal signs. Laboratory tests were normal. CT imaging revealed a 10 cm jejunojejunal intussusception with a suspected intraluminal lesion at the lead point.

The patient underwent urgent exploratory laparotomy. The intussusception was confirmed and manually reduced. A firm, well-circumscribed 5 cm mass was palpated in the jejunum. Segmental small bowel resection with primary anastomosis was performed. Postoperative recovery was uneventful, and the patient was discharged on day 3.Histopathology confirmed metastatic osteosarcoma.

Conclusion
This case demonstrates the rare event of osteosarcoma metastasis causing jejunojejunal intussusception. New gastrointestinal symptoms in osteosarcoma patients should prompt evaluation for metastases. Surgical resection provides both treatment and diagnosis. Early diagnosis and intervention improve outcomes in complex oncologic cases.