Ileocolic intussusception caused by ileal lipoma: A case report

Adult intussusception with multiple intestinal adhesions: A case report

Intussusception occurs when a part of the intestine enters another segment of the intestine causing bowel obstruction. It is common in children but not in adults with only <5% of prevalence of all intussusceptions. Most of the cases have an underlying neoplastic pathology. However, we found a case where an adult patient with 2 weeks of ileus obstruction is caused by intussusception with multiple intestinal adhesions. A 59-year-old man complained of being unable to defecate, or vomit and had a tender abdomen for 2 weeks. Contrast abdominal CT showed a dilated and thickened intestinal wall, with ileo-ileal intussusception in the distal terminal ileum, indicating a diagnosis of ileus obstruction due to intussusception. During laparotomy, intussusception was found but released spontaneously followed by ancillary findings were multiple adhesions in the ileum that caused the intussusception and obstruction. In conclusion, transient intussusception in adults with multiple adhesions has never been reported before, and a CT scan is an important clinical tool to diagnose and identify the cause of this condition. Recognizing the imaging abnormalities earlier is important to prevent further complications.

Terminal Ileum Lipoma Causing Ileocolic Intussusception: A Case Report and Literature Review

Adult intussusception is much rarer than pediatric intussusception and usually occurs secondary to a pathological lead point, most frequently neoplasm. Terminal ileum lipomas are an infrequent cause of adult ileocolic intussusception but can be seen together with the intussusception on initial imaging evaluation, which can guide appropriate diagnosis and management. We describe a case of a 42-year-old man presenting with 12 hours of severe right lower quadrant pain. CT of the abdomen and pelvis demonstrated an ileocolic intussusception with fat-density lesions within the intussusception as well as in the distal ileum. The patient went to the operating room for laparoscopic ileocolic resection, during which ileo-ileal and ileocolic intussusceptions were identified in the terminal ileum and multiple fatty masses were palpated in the terminal ileum and cecum. Following ileocecectomy, surgical pathology confirmed terminal ileum with intussusception associated with multiple submucosal lipomas. We also review the literature for cases of ileocolic intussusception caused by terminal ileum lipomas. Patients presented with both acute and chronic symptoms, and while CT was the most common modality used for diagnosis, ultrasound and colonoscopy were also able to identify the intussusception. Although the intussusception was initially reduced in two patients, all patients ultimately underwent surgical resection.

OUP accepted manuscript

Intussusception in adults is rare, and the clinical symptoms of intussusception are subtle, making the diagnosis quite challenging. Gastrointestinal lipomas are rare benign tumors and are essentially adipose growths, most frequently found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. Intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity, and the diagnosis of duodenal lipoma mainly depends on endoscopy examination, supplemented by computed tomography and magnetic resonance imaging. The present report describes a case of jejunal intussusception in an adult with a history of intermittent colicky abdominal pain located in the left upper quadrant over the last month. Contrast-enhanced computed tomography of the abdomen showed the typical target sign of a small intestinal intussusception along the left upper quadrant and a well-defined, low-density tumor in the intussusception. Exploratory laparotomy revealed jejuno-jejunal intussusception secondary to a lipoma, which was successfully treated with segmental intestinal resection.