Small bowel intussusception as a rare presentation of metastatic uterine leiomyosarcoma

Uterine leiomyosarcoma (uLMS) is a rare and aggressive cancer, commonly metastasising to the lungs and liver. However, small bowel metastasis, especially causing intussusception, is exceedingly rare. We report a woman in her 60s who developed acute small bowel obstruction 22 months after her initial uLMS diagnosis and treatment for bone metastases. Despite being stable on adjuvant therapy, her CT scan confirmed bowel obstruction with intussusception-suggestive findings, though a clear neoplastic lead point was not initially identified. Emergency laparotomy subsequently revealed intussusception with a tumour as the lead point, which histopathology confirmed as metastatic leiomyosarcoma. This case underscores the importance for clinicians to maintain a high index of suspicion for metastatic disease, even at uncommon sites, in patients with a uLMS history presenting with acute abdominal symptoms, regardless of the time elapsed since the primary diagnosis.