Background:

Renal carcinoma is the third most common urological cancer, with 30% of patients presenting with metastases at diagnosis. Metastases to the small intestine are rare (0.7–1.1%), and their presentation as intestinal intussusception is even more uncommon, with only a few cases reported in the literature.

Aims:

The aim of the study was to present a case of stage IV clear cell renal carcinoma with a rare presentation of intestinal intussusception, leading to emergency department admission due to severe anemia and melena.

Methods:

A 62-year-old man presented with melena for 2 months and a critically low hemoglobin level of 2.9 g/dL (normal range: 13.5–17.5 g/dL). Abdominal and pelvic angiotomography identified an exophytic lesion in the left kidney consistent with renal carcinoma and an approximately 16 cm ileal intussusception.

Results:

Exploratory laparotomy revealed intestinal intussusception and a 4 cm lesion on the antimesenteric border, suspected to be a tumor. A segmental resection with primary anastomosis was performed, resulting in a favorable postoperative recovery. Histopathological and immunohistochemical analyses confirmed poorly differentiated metastatic clear cell renal carcinoma.

Conclusions:

This report underscores the need to consider gastrointestinal symptoms in patients with renal carcinoma, as an intestinal metastasis, although rare, is a potential complication. Synchronous metastases are even rarer and present a significant diagnostic challenge.

INTRODUCTION

Brunner gland adenoma (Brunerroma or hamartoma) is a rare, benign lesion of the Brunner's glands, accounting for 10.6% of benign duodenal tumors¹⁰. It is predominantly seen in the 5^th to 6^th decades and with no gender predilection¹³. It is often an incidental finding during esophagogastroduodenoscopy or imaging studies. In symptomatic patients, clinical manifestations include gastrointestinal bleeding, duodenal obstruction, abdominal pain, ampullary obstruction, or intussusception^8,9. Given their potential to be mistaken as cancer, it is important to consider it in the differential diagnosis of duodenal masses¹⁴. As there have been reports of focal cellular atypia and adenocarcinoma within the lesion, resection, whether endoscopic or surgical is recommended for suspected Brunneromas³.

We report here a case of Brunneroma, which presented as gastrointestinal stromal tumor (GIST) with intussusception on radiological and endoscopic studies and brief review of literature.