Colonic intussusception caused by a sigmoidal lipoma: A case report

Colo-colonic intussusception secondary to giant colonic lipoma in an adult: A case report

INTRODUCTION

Intestinal intussusception is a rare complication in adults, accounting for 1 % of intestinal obstructions. Unlike in children, it is often secondary to a malignant lesion, rarely a benign one. Colonic lipomas are asymptomatic benign tumors often discovered incidentally. Colo-colonic intussusception due to a lipoma is exceptional. Here, we report a rare case of colo-colonic intussusception secondary to a giant caecal lipoma occurring in a 65-year-old woman.

CASE PRESENTATION

A 65-year-old woman, was admitted in our surgical department for intermittent crampy abdominal pain in the right iliac fossa with an alternation of diarrhea and constipation over the past 10 months. The radiological investigation revealed a colo-colonic intussusception, most likely secondary to a fatty mass in the cecum. A right hemicolectomy was performed with ileocolic anastomosis because of the risk of malignancy. Histopathological examination confirmed the lipomatous nature of the lesion. The patient remained asymptomatic three years after surgery.

CLINICAL DISCUSSION

Colonic lipomas are often asymptomatic. They can cause intussusception with clinical symptoms varying based on their size and location. CT scan has increased the number of preoperative diagnoses. Treatment options include surveillance, endoscopic intervention, or surgical resection. The appropriate surgical intervention remains a major challenge for surgeons due to the risk of malignancy.

CONCLUSION

A giant colonic lipoma remains a very rare cause of colonic intussusception, especially in adults. CT scan plays a crucial role in diagnosis. Surgical resection remains the treatment of choice due to the risk of malignancy.

Small bowel lipoma and intussusception: a case report

Intussusception is defined as the telescoping of bowel into itself. Intussusception is the leading cause of bowel obstruction in children, but it is rare in adults [1, 2]. It has a pathological intramural or extramural lead point. In adults, it accounts for 1%-5% of cases of bowel obstruction [3, 4]. Unlike presentation in the paediatric population of cramping abdominal pain, bloody mucus, and palpable mass in right iliac fossa, presentation in adults can be more varied and non-specific [1, 4]. Hence, diagnosis of small bowel intussusception (SBI) can be challenging, requiring a higher degree of clinical suspicion [5]. While cases of paediatric intestinal intussusception are often primary, most adult cases are secondary to structural lesions [5]. This case is of a 57-year-old lady who presented with SBI secondary to a small bowel lipoma (SBL), reflecting the importance of considering SBL as a differential in the causes of SBI.

Colon Lipoma Causing Colo-Colic Intussusception in an Adult: A Case Report from Tanzania

Intussusception is rarely seen in adulthood but is commonly seen in the pediatric age group. Causes of intussusception in adults are commonly due to tumors and inflammatory diseases. Intussusception in adults accounts for less than 5% of intestinal obstruction. Colonic lipomas are usually asymptomatic and are mostly managed surgically with promising outcomes as seen in our case.

Colonic lipoma mimicking malignancy and presenting as an intussusception: A rare case report

INTRODUCTION AND IMPORTANCE

Lipomas of the gastrointestinal tract are a rare entity compared to the more common tumors of the gut, such as adenomatous polyps and carcinomas. They were first described by Bauer in 1757. Gastrointestinal lipomas can grow in all segments of the gut, with the highest frequency in the colon. In this case report, we present a rare case of gastrointestinal lipoma mimicking colonic malignancy and causing intussusception, necessitating emergent surgery. This paper highlights the potential diagnostic challenges and therapeutic interventions associated with GI lipomas.

CASE PRESENTATION

A 28-year-old female presented with symptoms of abdominal pain, weight loss, vomiting, and changes in bowel habits. Initially, she received a misdiagnosis of Irritable Bowel Syndrome. Subsequent investigations indicated the possibility of colonic malignancy. During the intra-operative biopsy, it was ultimately discovered that she had a colonic lipoma.

CLINICAL DISCUSSION

CT revealed an abdominal mass and an intussusception, indicating the need for surgical intervention. A laparoscopic procedure was performed to remove the mass, which alleviated the symptoms. Subsequently, a histological examination confirmed the mass to be a lipoma.

CONCLUSION

Differentiating a gastrointestinal lipoma from malignancy is crucial, and careful investigation is necessary to determine if a local excision can be performed instead of a wide excision.

Ileocecal Intussusception With Lipoma as a Lead Point Leading to Small Bowel Obstruction in an Elderly Male: A Case Report

Intussusception with a lipoma as a lead point and associated bowel obstruction is very uncommon in adults. The patient presents with abdominal pain and intermittent or sudden intestinal obstruction requiring surgical intervention. We report the case of a 68-year-old male who presented with complaints of severe abdominal pain, nausea, vomiting, and constipation. A CT scan revealed ileocecal intussusception with a lipoma as a lead point. Evidence of small bowel obstruction and ascites was also noted on imaging. The patient underwent an ileocecal resection followed by an ileocolic side-to-side anastomosis. Pathological examination of the specimen revealed two adjacent submucosal lipomas with focal mucosal ischemic hemorrhagic changes of the large distal lipoma. We present this case owing to its rarity and believe that it will serve to broaden the horizon of research regarding intussusceptions secondary to submucosal lipomas.

Colonic lipoma of the hepatic flexure causing invagination in an adult

Intussusception is a rare condition in adults that can lead to intestinal obstruction due to malignant or benign lesions in the wall of the colon. Among the benign causes, lipomas are adipose tissue tumors that are most frequently located in the ascending colon. Invagination is characterized by nonspecific symptoms and normal laboratory test results. The exact point of invagination can be detected using advanced imaging studies such as abdominal computed tomography and colonoscopy. Invagination is treated surgically. Here, we presented the case of a female patient with colo-colonic invagination caused by a large lipoma diagnosed by computed tomography who underwent right hemicolectomy with primary ileocolonic anastomosis.

Large colonic lipoma as a lead point for intussusception in an adult

Intussusception is the telescoping of proximal loop of the bowel within distal loop resulting in obliteration of the lumen. Although it frequently occurs with the most common cause of intestinal obstruction in children, it is a rare phenomenon and an uncommon cause of acute intestinal obstruction in adults. Unlike pediatric intussusception, where the cause is idiopathic, adult intussusception is associated with underlying pathology as a lead point. The underlying pathology usually is malignant, but the prognosis is better when there is a benign lead point. The benign lead point intussusceptions are rare and are treated with reduction when there are no signs of ischemia. When there is ischemia or when reduction is not feasible, they are treated with surgical resection. In this report, we describe a rare case of an adult intussusception from a large colonic lipoma in a 79-year-old male, treated successfully with surgical resection.

Colonic lipomas revisited on CT colonography

PURPOSE

CT colonography (CTC) is growing in its utilization as a nationally approved colorectal cancer screening test. After colonic polyps, lipomas are the second most common colonic lesions and their accurate and rapid recognition are important.

METHODS

This retrospective Institutional Review Board approved study was performed at two large academic university-based institutions. 1044 patients underwent CTC at Institution A from 2010 to 2018 and 1094 patients underwent CTC at Institution B from 2003 to 2015. All CTC examinations with at least one colonic lipoma in their report were evaluated by a fellowship-trained abdominal imaging radiologist. 47 CTC examinations containing 59 colonic lipomas were detected and included. Segmental location, sessile versus pedunculated morphology, multiplicity, average attenuation, and largest lesion diameter were evaluated. A review of the current literature on colonic lipomas is entailed.

RESULTS

The overall incidence of colonic lipoma was 2.2% in women and 2.3% in men. Mean age for detection of colonic lipomas on CTC was 66.9 years. Segmental locations of colonic lipomas include ascending colon (39%), transverse colon (19%), ileocecal valve (12%), cecum (12%), descending colon (10%), and rectosigmoid (8%). 9% of colonic lipomas were multiple, 42% were pedunculated, and 58% were sessile. The mean (range) size of detected lipomas was 19 (6-59) mm. The mean (range) attenuation was - 132 (- 41 to - 258) HU.

CONCLUSION

Most colonic lipomas are located in the ascending colon. Although they are typically solitary, just under 10% are multiple, and although they are most often sessile, slightly under half are pedunculated mimicking polyps. CTC detects smaller lipomas than optical colonoscopy.

A Rare Case of Colo-Colonic Intussusception Caused by Colonic Submucosal Lipoma

Unlike in infancy, where intussusception is an abdominal emergency, diagnosis of intussusception could be tricky in adults as most of these patients present sub-acutely with vague abdominal symptoms. Early diagnosis could impact these patients significantly in decreasing morbidity and mortality along with reduction in healthcare expenses. Colo-colonic intussusception is rare and accounts for less than 20% of adult intussusception. More than 50% of adult intussusception is caused by mass-like lesions. In such cases, this could be an early presentation of malignant intestinal lesions. Abdominal CT is mandatory in all adult patients; when combined with ultrasound, it has 95.5% accuracy of pre-operative diagnosis. Here we report a case of a 42-year-old female who presented with a two-month history of intermittent abdominal pain; a CT abdomen revealed colo-colonic intussusception which was initially missed on prior imaging. We discuss the importance of considering intussusception as a rare differential of abdominal pain, the need for early diagnosis, and the role of colonoscopy and non-surgical management in adults.

Management Options of Giant Colonic Lipomas

Colonic lipomas are rare, benign neoplasms, typically asymptomatic, and predominantly found incidentally during autopsy or routine surveillance. Symptomatic lesions are usually those greater than 2 cm in diameter while “giant” lesions are characterized as those over 4 cm. Presentations can vary from asymptomatic to more severe sequelae, including obstruction, gastrointestinal bleeding, or intussusception. Resection of these lesions has historically been restricted to large or symptomatic lesions. However, recent reports suggest lipomas may retain the ability to grow and can become symptomatic over time despite being inconsequential initially. This series provides a review of the clinical manifestations of colonic lipomas, radiographic characteristics, and a treatment recommendation for management of these lesions using minimally invasive surgical techniques whilst advocating for consideration of resection prior to the development of symptoms or more emergent complications.

Intussusception related to transverse colonic lipoma: a case report and review of the literature

Lipomas are rare and benign colonic soft tissue lesions derived from mature adipocytes. Their poor clinical expression usually leads to a coincidental discovery during procedures like colonoscopy, imagery, surgery or autopsy. Due to their small size, a simple observation would usually be recommended. However, colonic lipomas (CLs) with clinical symptoms or signs including abdominal pain, nausea, vomiting, diarrhea, anaemia or even intussusception would need invasive treatment. It is recommended to perform surgery to treat CLs that are >2 cm. Endoscopic procedures could be an interesting alternative for the future but would still require further investigation. We report the case of a 30-year-old patient with transverse CLs leading to obstruction of the descending colon by intussusception and continue by presenting a review of the current literature.

Colonic Lipoma as a Leading Cause of Intussusception Resulting in Bowel Obstruction

A colon lipoma is defined as a benign tumor made of adipose tissue present in the submucosa. Lipomas of the colon are unusual with a frequency of 0.035%-4.4%. We present an uncommon case of a 41-year-old female with left colonic lipoma causing intussusception. The patient presented with abdominal pain at the left iliac fossa. She underwent an emergency exploratory laparotomy plus left hemicolectomy and was followed in the surgical out-patient clinic postoperatively. She was found doing well taking a normal diet and having normal bowel habits. The overall prognosis depends on the complete removal of the tumor.

Management of Adult Intussusception-A Case Series Experience from a Tertiary Center

BACKGROUND

The management of intussusception is controversial. Clinical presentation, with the aid of imaging modalities, enables a better selection of patients for the appropriate treatment algorithm. Conservative management versus surgical intervention with bowel resection is considered accordingly.

METHODS

Retrospective review of a computerized database of patients who were admitted with intussusception between January 1, 2010, and December 31, 2020, in a single tertiary center in Israel. Patients who were treated conservatively were compared to those who underwent surgery. Patients who underwent bowel resection were compared to those that had surgery without a resection.

RESULTS

A total of 76 patients were diagnosed with intussusception, and 49 were operated. Bowel resection was performed in 32 cases. 20/76(26%) were successfully managed conservatively. Patients with a lead point (OR = 5.59) and colonic involvement (OR = 13.72) had a higher likelihood for resection. The likelihood of bowel resection was found to be significantly lower with proximal small bowel intussusception (OR = 0.071).

CONCLUSION

Young patients presenting with intussusception may be treated conservatively when adequate criteria are met in order to avoid unnecessary surgical interventions.

Laparoscopic Resection of an Acute Rectosigmoid Intussusception Due to a Giant Pedunculated Lipoma

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.

Colo-colic intussusception secondary to colon lipoma: A case report

•

Intestinal intussusception is rare in adults and it is associated with lead points.

•

Lipomas are very rare benign tumors which may act as lead points for intestinal intussusception.

•

Colo-colic intussusception caused by lipoma must be considered in the differential when diagnosing adults with right lower quadrant pain.

Introduction and importance

Intestinal intussusception is rare in adults and it is associated with lead points affecting the colon in around 17% of patients. Lipomas are very rare benign tumors which may act as lead points for intestinal intussusception. Indeed, the incidence of intestinal intussusception is much rare when caused by lipomas.

Case presentation

Our patient is a 29-year-old male, previously healthy and admitted for severe right lower quadrant abdominal pain of 2-day duration. Computed tomography (CT) scan of the abdomen and pelvis showed large mass of fat consistency containing colon structure.

Clinical Discussion

Urgent laparotomy was opted during which colo-colic intussusception was diagnosed and right hemicolectomy with primary ileocolic anastomosis was performed. Pathology report showed that intussusception was induced by a colon lipoma. Patient had an uneventful hospital stay and was discharged on post-operative day 5.

Conclusion

Thus we recommend that colo-colic intussusception caused by lipoma be considered in the differential when diagnosing adults with right lower quadrant pain.

Pedunculated sigmoid lipoma causing colo-colonic intussusception

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.

Ileocolic intussusception due to intestinal lipoma in an adult patient

Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.

Giant lipoma of descending colon masquerading as a colonic malignancy

Lipomas of the large intestine are uncommon tumour. They are often innocuous and do not cause any clinical problem, particularly if they are small (<2 cm) is size. However, they can give rise to significant clinical symptoms if they become large and can be mistaken for colorectal carcinoma. Herein, a giant submucosal lipoma of descending colon is described, which was preoperatively suspected of carcinoma and underwent left hemicolectomy. The diagnosis was only reached after pathological examination of the resected tumour. The case highlights that a large colonic lipoma still poses diagnostic difficulty. Accurate diagnosis of the lipomas is important as they can be removed by endoscopic polypectomy or segmental resection, obviating the need of unnecessary major surgical resection.

Ileo-caecal intussusception secondary to lipoma in an adult: A rare cause for intestinal obstruction

Intussusception in adults is a rare condition. Unlike in children, it is often associated with a pathologic lesion that serves as a lead point. We report an unusual case of ileo-caecal intussusception due to lipoma. A 51-year-old male presented with symptoms and signs of intestinal obstruction. CT scan revealed bowel obstruction, resulting from ileo-caecal intussusception with the lead point being a lipoma of the terminal ileum. Ileocaecal resection with primary anastamosis was performed with histology confirming lipoma. Intussusception is not a common cause for intestinal obstruction in adults and is best diagnosed with CT scan. Surgical resection remains the definitive treatment in adult intussusception.

An unusual case of colonic intussusception in old age

Intussusception refers to the telescoping of a bowel segment into the lumen of an adjacent distal bowel. It is a rare entity and an uncommon cause of intestinal obstruction in adults. Approximately 90% of cases of intussusception in adults have an organic cause as a lead point. Usually, the patient presents with signs of acute abdomen with a short history. Although it is difficult to diagnose colonic intussusception clinically, medical imaging by ultrasonography and computed tomography can easily detect this rare but clinically important disease. This case report describes an uncommon location of intussusception in the colon in a 70-year-old female patient.