PMY Tang, NSY Chao

Abstract

Aim: Osteosarcoma typically metastasizes to the lung and the brain via haematogenous spread. Intestinal spread is uncommon. Data on the management protocol for metastatic lesion in the small bowel causing ileo-ileal intussusception in children is lacking. Methods: We reported a case of a 17-year-old boy with known past history of pulmonary, brain and soft tissue metastatic osteosarcoma, presenting with intestinal obstruction. His clinical presentation and management pathway was discussed. Results: A 17-year-old boy with left femur osteosarcoma five years ago presented with vomiting and abdominal pain for one day. He had known past history of pulmonary, brain and right left soft tissue osteosarcoma metastasis. On admission, he remained haemodynamically stable with a full GCS score. Abdominal X-ray showed prominent small bowel loops. Computed tomography abdomen showed ileo-ileal intussusception with suspicious intestinal metastasis. Emergency laparotomy showed ileo-ileal intussusception, small bowel resection and anastomosis were performed. Histology findings of the resected specimen confirmed metastatic osteosarcoma into small bowel. Post op recovery was uneventful and patient was able to tolerate full oral feeding on day 9 post operatively. Conclusion: In patient with metastatic osteosarcoma, one of the potential causes of intestinal obstruction could be ileo-ileal intussusception with pathological lead point. In comparsion with the more common peritoneal metastasis presenting with carcinomatosis in the adult population, isolated intra-luminal intestinal metastasis is a more readily surgically treatable condition. High index of suspicion and early surgical intervention were essential in children with metastatic osteosarcoma.