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Dimopoulos P, Akrida I, Gogos GP, Leivaditis V, Verras GI, Tasios K, Antzoulas A, Garantzioti V, Drakos N, Mulita F. A case report of an idiopathic adult ileocolic intussusception. PRZEGLAD GASTROENTEROLOGICZNY 2024; 19:217-219. [PMID: 38939070 PMCID: PMC11200065 DOI: 10.5114/pg.2024.138804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/15/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Platon Dimopoulos
- Department of Interventional Radiology, General University Hospital of Patras, Patras, Greece
| | - Ioanna Akrida
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - George-Pappas Gogos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | | | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Nikolas Drakos
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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2
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Heng V, Oh S, Leng H, Chhun V, Lee YD. Adult colorectal intussusception caused by giant lipoma-A case report. Clin Case Rep 2024; 12:e8682. [PMID: 38562575 PMCID: PMC10982120 DOI: 10.1002/ccr3.8682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
Key Clinical Message Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma. Abstract Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55-year-old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid-sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end-to-end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.
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Affiliation(s)
- Vouchly Heng
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Suk‐Kyu Oh
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Hour Leng
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
| | - Vireak Chhun
- Department of PathologyHebron Medical CenterPhnom PenhCambodia
| | - Young Don Lee
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
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3
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Lai ZB, He J, Zhang JY. Sigmoidorectal Intussusception Caused by Sigmoid Cancer. J Gastrointest Surg 2023; 27:3111-3112. [PMID: 37620659 DOI: 10.1007/s11605-023-05811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Zhen-Bin Lai
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Jie He
- Department of Gastroenterology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
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Piñerúa-Gonsálvez JF, Del Pozo Calzada C, Zambrano-Infantino RDC. Adult sigmoidorectal intussusception as an unexpected cause of lower gastrointestinal bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:464-465. [PMID: 36412482 DOI: 10.17235/reed.2022.9333/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
A 95-years-old woman presented with sudden-onset rectal bleeding. All other systems were reviewed and were negative. The patient had a past medical history of Alzheimer disease, congestive heart failure, arterial hypertension and diabetes mellitus type 2. Vital signs were normal. There were neither signs of peritoneal irritation nor intestinal obstruction. On digital rectal examination, a soft mass was palpated about 9 cm from the anal verge. Routine analytical tests were within normal limits. The abdominal CT showed a sigmoidorectal intussusception. It was performed a colonoscopy revealing a segment of sigmoid telescoping into the rectum about 15cm from the anal verge. On this invaginated segment, there was a large sessile polyp, which was biopsied. Rectal bleeding was self-limited without additional measures. The histological examination showed tubular adenoma with high-grade dysplasia. Intussusception in the adult is uncommon, representing less than 5% of all cases of intussusception. Most of the cases are due to malignant lesions, which are pulled forward during peristalsis, leading to invagination. The early diagnosis represents a diagnostic challenge due to the clinical features are nonspecific, including symptoms of intestinal obstruction and rectal bleeding.
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5
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Palle LRA, Inban P, Akuma O, Akuma CM, Srirama HA, Thakkar K, Hanafi IS, Dahal R, Yousuf MA, Khan AM, Kelechi AE. Intussusception in an elderly female and its management: A case report and literature review. Clin Case Rep 2023; 11:e7745. [PMID: 37575458 PMCID: PMC10415582 DOI: 10.1002/ccr3.7745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Intussusception is the telescoping or invagination of the proximal part of the gastrointestinal tract into an adjacent section. It is rare in adults, accounting for 1% of adult bowel obstruction. Adult presentation of intussusception is variable, with nonspecific, vague symptoms like abdominal pain, nausea, vomiting, and rectal bleeding. Abdominal computed tomography (CT) scans have the highest sensitivity in the diagnosis of intussusception. The classical findings of intussusception are the target sign and mesenteric vessels lined within the bowel lumen. An abdominal CT scan can reveal a cloverleaf figuration, fluid-filled ileal loops, superior mesenteric venous (SMV) occlusion, and concerns about ongoing sealed perforation or fistulization. Our patient is an 86-year-old female who was diagnosed with a jejunal-jejunal long-segment intussusception, gastro-enteric fistula, and SMV occlusion with distal reconstitution. The patient responded well to conservative treatment and was discharged for follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Rojaj Dahal
- Manipal College of Medical Sciences (MCOMS)PokharaNepal
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6
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Nureta TH, Girma T, Muleta LE, Hussen A, Mohammed TP. Giant lipoma of the colon presenting as a case of adult intussusception: A case series. Int J Surg Case Rep 2023; 106:108279. [PMID: 37148723 DOI: 10.1016/j.ijscr.2023.108279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Lipoma of the intestine is one of the uncommon benign tumors of the alimentary tract first reported by Bauer in 1957. The peak incidence is usually seen between 50 and 60 years of age and more commonly in females. They are usually either asymptomatic or mildly symptomatic. The occurrence of symptoms is mostly related to the diameter of the lesion. PRESENTATION OF CASE We present a single center consecutive case of three patients who had giant colonic lipomas presented with colonic intussusception. Two of the cases presented for the first time with an emergency condition: acute intestinal obstruction. The mode of presentation, diagnosis, and management outcome of colonic lipoma was assessed. DISCUSSION Symptomatic lipoma may present with non-specific abdominal pain, change in bowel habits, intussusception, and hemorrhage. The clinical diagnosis is usually challenging, given the non-specificity of symptoms of the disease. Computed tomography is considered to be a diagnostic modality of choice in recognizing the presence of lipoma. However, a definitive diagnosis of lipoma is usually obtained after a histopathologic examination of the resected specimen. The management of colonic lipoma depends on the size of the lesion and the presence or absence of symptoms. CONCLUSION Colonic lipoma is a rare benign tumor that occurs in the elderly, frequently misdiagnosed as a malignant tumor. Despite the rarity of the disease, lipoma should be considered in the differential diagnosis of large bowel tumors and adult intussusception.
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Affiliation(s)
- Tilahun Habte Nureta
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia.
| | - Tadesse Girma
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
| | - Lemesa Elias Muleta
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
| | - Abdurazak Hussen
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
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Tian J, Bhatia S, Mourad Y, Hall P, Louis MA, Khan N. A feeding jejunostomy causing an intussusception – case report and literature review. J Surg Case Rep 2022; 2022:rjac446. [PMID: 36158250 PMCID: PMC9491870 DOI: 10.1093/jscr/rjac446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Use of enteral nutrition has increased dramatically over the past two decades due to improved nutritional formulas, better quality feeding tubes and the ability to use less invasive endoscopic, fluoroscopic and laparoscopic techniques. Intussusception accounts for 1–5% of adult intestinal obstructions, with feeding tubes acting as a lead point in < 1% of cases. Since intussusception is rare, especially in adults, it is not always considered in the initial differential diagnosis of patients presenting with abdominal pain, nausea, vomiting or constipation. If left untreated, intussusception can eventually lead to bowel compromise, poor outcomes and even death. Therefore, prompt recognition and correction are necessary. We present a case of small bowel obstruction in an elderly male secondary to a tube-related intussusception. A review of the signs, symptoms and treatment recommendations is provided.
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Affiliation(s)
- Jane Tian
- Department of Surgery, Flushing Hospital Medical Center , New York , USA
| | - Shubham Bhatia
- Department of Surgery, Flushing Hospital Medical Center , New York , USA
| | - Youssef Mourad
- Department of Surgery, Flushing Hospital Medical Center , New York , USA
| | - Philip Hall
- Ross University School of Medicine , Bridgetown , Barbados
| | - Martine A Louis
- Department of Surgery, Flushing Hospital Medical Center , New York , USA
| | - Noman Khan
- Department of Surgery, Flushing Hospital Medical Center , New York , USA
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Chandanwale S, Sutreja D, Yadav S. A giant colonic submucosal lipoma: An uncommon cause of colo-colonic intussusception with review of literature. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_737_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Qiryaqoz ZA, Katiyar U, Shebrain S. Recurrent Right Upper Quadrant Pain Masquerading an Underlying Colon Adenocarcinoma-Induced Intussusception. Case Rep Gastroenterol 2021; 15:501-506. [PMID: 34616247 PMCID: PMC8454228 DOI: 10.1159/000516863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
Intussusception in adults is a challenging diagnosis that often requires a high degree of suspicion. In adults presenting with symptoms, almost 90% have underlying neoplasms. Most frequently, the presentation will include nonspecific abdominal pain, vomiting, and mucoid hematochezia. In this case, we present a 39-year-old female with a rare presentation of chronic, recurrent right upper quadrant abdominal pain over a 5-month interval. The misleading presentation with which the patient presented led to a delay in diagnosis and treatment of colon malignancy and serves to advocate for intussusception as a differential for adult patients presenting with obstructive symptoms of unknown origin and recurrent abdominal pain. Such cases should persuade physicians to plan prompt surgical intervention as to not delay optimal diagnostic and therapeutic outcomes.
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Affiliation(s)
- Zeena Ayad Qiryaqoz
- Western Michigan University Homer Stryker, School of Medicine, Kalamazoo, Michigan, USA
| | | | - Saad Shebrain
- Bronson Methodist Hospital, Kalamazoo, Michigan, USA
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10
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Zippi M, Toma A, Paoluzi N, Maccioni F, Pica R. An Ulcerated Large Colic Lipoma Causing Rectorrhagia Treated With Endoscopic Loop-Assisted Resection. Cureus 2021; 13:e14321. [PMID: 33968531 PMCID: PMC8101558 DOI: 10.7759/cureus.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Colonic lipomatous polyps are often an incidental finding during colonoscopy. Generally, these types of polyps can cause gastrointestinal bleeding when they are larger than 4 cm in size. Some case reports have documented the occurrence of overlying adenomatous formations in the apical portion, as well as ulcerated mucosa. There is currently no standardized endoscopic removal technique for their treatment. In this report, we present a case of a large and ulcerated lipoma causing rectorrhagia, which was successfully treated with endoscopic en-bloc resection and endoloop placement.
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Affiliation(s)
- Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Antonella Toma
- Unit of Urgent Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Nada Paoluzi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Francesca Maccioni
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Policlinico Umberto I, Rome, ITA
| | - Roberta Pica
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
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11
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Sohn J, Knox RD, Gilmore A. Laparoscopic Resection of an Acute Rectosigmoid Intussusception Due to a Giant Pedunculated Lipoma. Cureus 2021; 13:e13798. [PMID: 33717770 PMCID: PMC7944426 DOI: 10.7759/cureus.13798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Intussusception is the invagination and telescopic migration of a proximal segment of the gastrointestinal tract distally and is classically described in the paediatric age group, accounting for 95% of reported cases. Intussusception in adults is highly uncommon; its aetiology involves a wide spectrum of pathologies, namely, concerning malignancy and differing management pathways. In the management of adult intussusception, consideration must be given to the potential malignant nature of the lesion, as reducing a malignant segment could render dissemination. Intussusception with non-malignant lesions like lipomas has been described, usually involving the right and transverse colons. In this case report, we review a rare case of adult colorectal intussusception secondary to a submucosal sigmoid lipoma.
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Affiliation(s)
- Jenny Sohn
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, AUS.,School of Medicine, University of New South Wales, Sydney, AUS.,General Surgery, St George Hospital, Kogarah, AUS
| | - Robert D Knox
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, AUS.,Department of General Surgery, Orange Base Hospital, Orange, AUS
| | - Andrew Gilmore
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, AUS.,Department of Colorectal Surgery, Liverpool Hospital, Liverpool, AUS
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12
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Ford K, Lopez S, Synghal G, Fayiga Y, Carter B, Kandel A, Ford K. Pedunculated sigmoid lipoma causing colo-colonic intussusception. Proc (Bayl Univ Med Cent) 2021; 34:371-372. [PMID: 33953464 DOI: 10.1080/08998280.2021.1877510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This case report describes a 52-year-old man who presented with 2 weeks of left lower quadrant pain and bloody stool. Computed tomography revealed a 4 cm, fat-density mass acting as a lead point for intussusception of the sigmoid colon. Surgical resection was successfully performed, and histologic evaluation confirmed the diagnosis of a pedunculated colonic lipoma. Intussusception of the colon is uncommon in adults and is often associated with malignancy, but other nonmalignant causes such as a lipoma may also present similarly with obstructive symptoms, bloody stool, and/or intermittent abdominal pain. Colonic lipoma should be considered in the differential of a patient with clinical or imaging evidence of intussusception, with primary resection leading to an excellent prognosis.
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Affiliation(s)
- Kenneth Ford
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Samantha Lopez
- The University of Texas Southwestern Medical School, Dallas, Texas
| | - Gaurav Synghal
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | - Yomi Fayiga
- Department of Surgery, Baylor Scott and White Medical Center - Waxahachie, Waxahachie, Texas
| | - Brittany Carter
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Anuj Kandel
- Department of Surgery, Baylor Scott and White Medical Center - Waxahachie, Waxahachie, Texas
| | - Kenneth Ford
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
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13
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Costeira FDS, Gonçalves M, Esteves C, Rebelo A, Leite C. Colonic Lipoma as a Cause of Colocolic Intussusception. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 28:73-75. [PMID: 33564709 PMCID: PMC7841803 DOI: 10.1159/000508294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - Margarida Gonçalves
- Interno de Formação Especifica de Gastroenterologia, Hospital de Braga, Braga, Portugal
| | - Cátia Esteves
- Assistente Graduado de Radiologia, Hospital de Braga, Braga, Portugal
| | - Ana Rebelo
- Assistente Graduado de Gastroenterologia, Hospital de Braga, Braga, Portugal
| | - Carolina Leite
- Assistente Graduado de Radiologia, Hospital de Braga, Braga, Portugal
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14
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Sankari Tarabishi A, Aljarad Z, Shebli B, Masri AH, Anadani R, Shabouk MB, Trissi M. A rare case of bowel intussusception due to adenocarcinomatous polyp in a 14 year-old child: case report. BMC Surg 2020; 20:198. [PMID: 32917174 PMCID: PMC7488507 DOI: 10.1186/s12893-020-00859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is an uncommon condition in children older than 2 years and causes intestinal obstruction. On the contrary of adult intussusception, childhood intussusception does not usually happen on a lead point of a malignant organic lesion. CASE PRESENTATION A 14-year-old male presented with complaints of heavy, bilious emesis and periumbilical colicky pain. Ultrasonography showed a dilated intestinal loop with absent bowel movement. CT scan revealed two masses in the abdomen. We performed an exploratory laparotomy that revealed invaginated intestines and showed a polyp near the area of interest. Necrotic segments and the polyp were removed and examined pathologically. Pathology showed adenocarcinoma in the polyp. After surgery, the general condition of the patient was normal and no complications occurred. CONCLUSIONS Intussusception mainly occurs during infancy and early childhood. Mostly it is an idiopathic ileo-colic invagination. In our case, the patient had a jejuno-jejunal intussusception in his late childhood, and the lead point was an adenocarcinomatous polyp, which is rare in children. Amongst the many types of treatment, we chose surgical resection because of patient's age.
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Affiliation(s)
| | - Ziad Aljarad
- Department of Gastroenterology, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Baraa Shebli
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ahmad Humam Masri
- Department of Neurosurgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Rami Anadani
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | | | - Mazen Trissi
- Department of Surgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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15
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Ejtehadi F, Mohammed E, Vijay V. Laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma. J Surg Case Rep 2020; 2020:rjaa297. [PMID: 32855804 PMCID: PMC7443345 DOI: 10.1093/jscr/rjaa297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Colonic lipomas are the most widespread non-epithelial tumours of the large bowel. They often present with absent, non-specific or intermittent symptoms. Intussusception is the most common complication that may occur as a result of such a lesion. We present the case of a young female patient with a history of intermittent abdominal pain associated with nausea. She presented to the emergency department with subacute large bowel obstruction. A diagnosis of colo-colic intussusception due to a large descending colonic lipoma was confirmed on CT scan. The patient underwent a laparoscopic assisted submucosal excision of the lipoma. We discuss this unique operative technique as well as preoperative investigations and histopathology findings. Although successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma.
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Affiliation(s)
- Farshid Ejtehadi
- Department of Colorectal Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Elsamoual Mohammed
- Department of Colorectal Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Vardhini Vijay
- Department of Colorectal Surgery, The Princess Alexandra Hospital NHS Trust, Harlow, UK
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16
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Patita M, Nunes G, Fernandes V. Sigmoidorectal intussusception as the first manifestation of colonic neoplasia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Patita M, Nunes G, Fernandes V. Sigmoidorectal intussusception as the first manifestation of colonic neoplasia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:513-514. [PMID: 31519315 DOI: 10.1016/j.rgmx.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/21/2019] [Indexed: 11/25/2022]
Affiliation(s)
- M Patita
- Departamento de Gastroenterología, Hospital Garcia de Orta, Almada, Portugal.
| | - G Nunes
- Departamento de Gastroenterología, Hospital Garcia de Orta, Almada, Portugal
| | - V Fernandes
- Departamento de Gastroenterología, Hospital Garcia de Orta, Almada, Portugal; Departamento de Gastroenterología, CUF Clínica Almada, Almada, Portugal
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18
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Cordeiro J, Cordeiro L, Pôssa P, Candido P, Oliveira A. Intestinal intussusception related to colonic pedunculated lipoma: A case report and review of the literature. Int J Surg Case Rep 2019; 55:206-209. [PMID: 30771623 PMCID: PMC6376159 DOI: 10.1016/j.ijscr.2019.01.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 12/12/2022] Open
Abstract
Intestinal intussusception is a rare clinical entity in adults. When seen in adults, intussusception is often caused by a malignant condition. Colonic lipoma is a rare benign condition that can cause intussusception in adults. Computed tomography is the most sensitive radiological modality for diagnosis. The treatment of intussusception in adults is almost always surgical.
Introduction Intestinal intussusception is a relatively common cause of bowel obstruction in children, however, it is a rare clinical entity in adults. When seen in adults, it is often caused by some underlying condition, usually of malignant origin. We present a case of intestinal intussusception caused by a benign and rare condition in the gastrointestinal tract. Case presentation A 69-year-old male patient presented with diffuse abdominal pain for 2 months, which intensified in the last two days, associated with diarrhea, vomiting and weight loss, in addition to sporadic episodes of hematochezia. Colonoscopy revealed a vegetative-infiltrative lesion, occupying about 75% of the lumen of the colon, located in the hepatic angle, presumably neoplastic. A biopsy was performed, which revealed mild nonspecific chronic inflammation in activity, in fragments of colonic mucosa. CT scan demonstrated colo-colonic intussusception, associated to an oval formation presenting fat density, suggesting lipoma. The patient underwent laparotomy with intussusception reduction and right partial colectomy. The inspection of the specimen showed a yellowish, pedunculated lesion. Histopathology confirmed a 5.0 cm submucosal lipoma. Discussion Intestinal intussusception is relatively frequent in children and is a rare clinical condition in adults at a ratio of 20:1.4. Sixty to sixty-five percent of the cases of intussusception in the large intestine have malignant etiology. Thus, lipoma as the main cause of colo-colonic intussusception in adults is an uncommon cause. Conclusion Although rare, colonic lipoma should be considered as a differential diagnosis among the causes of large intestinal intussusception in adults.
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Affiliation(s)
- Johanna Cordeiro
- Departament of Radiology, Hospital Felicio Rocho, Av. do Contorno, 9530, Barro Preto, 30110-017, Belo Horizonte, MG, Brazil.
| | - Leonardo Cordeiro
- Departament of Radiology, Hospital Felicio Rocho, Av. do Contorno, 9530, Barro Preto, 30110-017, Belo Horizonte, MG, Brazil
| | - Paula Pôssa
- Departament of Radiology, Hospital Felicio Rocho, Av. do Contorno, 9530, Barro Preto, 30110-017, Belo Horizonte, MG, Brazil
| | - Paula Candido
- Departament of Radiology, Hospital Felicio Rocho, Av. do Contorno, 9530, Barro Preto, 30110-017, Belo Horizonte, MG, Brazil
| | - Alice Oliveira
- Departament of Surgery, Hospital Felicio Rocho, Av. do Contorno, 9530, Barro Preto, 30110-017, Belo Horizonte, MG, Brazil
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Core curriculum illustration: colonic intussusception due to pedunculated lipoma. Emerg Radiol 2018; 27:461-462. [PMID: 29860542 DOI: 10.1007/s10140-018-1613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
Abstract
This is the 48th installment of a series that will highlight one case per publication issue from the bank of cases available online as a part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at http://www.aseronline.org/curriculum/toc.htm .
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Mochizuki T, Hirata Y, Kitamura S, Nishida T, Sakimoto H. Laparoscopic operation after pre-operative reduction of an intussusception-induced inflammatory fibroid polyp. J Surg Case Rep 2017; 2017:rjx026. [PMID: 28458833 PMCID: PMC5400470 DOI: 10.1093/jscr/rjx026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/27/2017] [Indexed: 01/07/2023] Open
Abstract
Intussusception occurs mainly in children but rarely in adults. About 80–90% of adult cases of intussusception are due to benign or malignant neoplasms as a lead point. One of the causes is an inflammatory fibroid polyp (IFP), a rare, benign entity that occurs more frequently in the stomach than the ileum. We describe an uncommon case of a patient who presented with intussusception-induced IFP of the ileum. A 35-year-old woman presented with a 2-day history of abdominal pain. A computed tomography scan demonstrated ileocolic intussusception. During colonoscopy, reduction by pressured air easily released intussusception, and we suspected a submucosal tumour of the ileum. Successful pre-operative colonoscopic reduction was helpful for performing laparoscopic ileocecal resection 2 days later. Results of the histopathological examination confirmed a large IFP. The patient's post-operative course was uneventful. Pre-operative reduction by colonoscopy is effective for the diagnosis and treatment of intussusception-induced IFP.
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Affiliation(s)
- Tetsuya Mochizuki
- Department of Surgery, Chugoku Rosai Hospital, Kure-shi, Hiroshima, Japan
| | - Yuzo Hirata
- Department of Surgery, Chugoku Rosai Hospital, Kure-shi, Hiroshima, Japan
| | - Shosuke Kitamura
- Department of Internal Medicine, Chugoku Rosai Hospital, Kure-shi, Hiroshima, Japan
| | - Toshihiro Nishida
- Department of Diagnostic Pathology, Chugoku Rosai Hospital, Kure-shi, Hiroshima, Japan
| | - Hideto Sakimoto
- Department of Surgery, Chugoku Rosai Hospital, Kure-shi, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
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de Figueiredo LO, Garcia DPC, Alberti LR, Paiva RA, Petroianu A, Paolucci LB, Costa MRLG. Colo-colonic intussusception due to large submucous lipoma: A case report. Int J Surg Case Rep 2016; 28:107-110. [PMID: 27693869 PMCID: PMC5048079 DOI: 10.1016/j.ijscr.2016.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/19/2016] [Indexed: 02/08/2023] Open
Abstract
Intussusception is rare cause of chronic abdominal pain in adults. Colo-colonic intussusceptions caused by large submucous lipoma. Adults intusseption is rarely caused by idiopathic condition. Main causes are inflammatory diseases, benign or malignant tumors, adhesions and other mechanical conditions impairing peristalsis leading to chronic diarrhea. Inflammatory diseases, tumors, adhesions or mechanical conditions may lead to this patology. Colonoscopy contributes to diagnosis given that it provides direct visualization and biopsy.
Introduction Intussusception in adult is rarely caused by idiopathic conditions. Main causes are inflammatory diseases, benign or malignant tumors and motility disorders. As a benign cause, lipomas appear as a particularly rare gastrointestinal intraluminal tumor occurring with highest incidence in the colon, mostly in the caecum and ascending colon. Presentation of case A 57-year-old male patient was admitted at the surgical emergency in Belo Horizonte, with history of chronic and intermittent diffuse abdominal pain, associated with variations of his bowel habits and rare episodes of vomiting starting around 3 days prior to admission. Discussion Intussusception is the cause of adult symptomatic bowel obstruction in 1% of the cases and its colocolonic occurrence represents 17% of all intestinal intussusceptions in adults. The reported case presents itself as even rarer considering its evaluation according to the epidemiological statistics of 1:5 men/women ratio and lipoma’s most common location being the right colon. Intussusception and intestinal obstructions caused by intraluminal lipomas are not often described in the literature and its occurrence is directly related to its size, usually larger than 2 cm diameter. The management of lipomatous intraluminal lesions of the colon is traditionally surgical, and it allows a selective resection, depending on the size of the tumor, length of intussusception, and the amount of inflammation. Conclusion Patients with chronic abdominal symptoms and semi-obstruction caused by intussusception are rarely diagnosed before surgery unless there is a high index of suspicion. Colonoscopy contributes to diagnosis given that it provides direct visualization and biopsy.
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Affiliation(s)
| | - D P C Garcia
- Department of Surgery, Instituto de Ensino e Pesquisa da Santa Casa, Belo Horizonte, MG, Brazil
| | - Luiz Ronaldo Alberti
- Department of Surgery, FMUFMG and Instituto de Ensino e Pesquisa da Santa Casa, Belo Horizonte, MG, Brazil
| | - R A Paiva
- Colorectal Surgeon at Hospital Felício Rocho, Av do Contorno 9530, 30110-130, Belo Horizonte, MG, Brazil
| | - Andy Petroianu
- FMUFMG and Instituto de Ensino e Pesquisa da Santa Casa, Belo Horizonte, MG, Brazil
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Elmoghrabi A, Mohamed M, McCann M, Sachwani-Daswani G. Adult jejunojejunal intussusception in the face of jejunal adenocarcinoma: two infrequently encountered entities. BMJ Case Rep 2016; 2016:bcr-2016-214708. [PMID: 26961563 DOI: 10.1136/bcr-2016-214708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adult intussusception and small bowel adenocarcinoma are rarely encountered together. Intussusception should be considered in the differential diagnosis of adult patients presenting with abdominal pain, especially those with unremitting symptoms. Concomitant anaemia should lower the threshold for suspicion of underlying malignancy. Jejunal adenocarcinoma represents a rare, but possible aetiology.
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Affiliation(s)
| | - Mohamed Mohamed
- Trauma Services, Hurley Medical Center, Flint, Michigan, USA
| | - Michael McCann
- Trauma Services, Hurley Medical Center, Flint, Michigan, USA
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