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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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2
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Suleiman J, Suleman M, Mremi A, Sadiq A, Mohamedali A, Machaku D, Lodhia J. Colon Lipoma Causing Colo-Colic Intussusception in an Adult: A Case Report from Tanzania. Case Rep Surg 2024; 2024:7777258. [PMID: 38223374 PMCID: PMC10787654 DOI: 10.1155/2024/7777258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/22/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
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.
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Affiliation(s)
- Jamil Suleiman
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - Mujaheed Suleman
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
- Department of Pathology, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - Adnan Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
- Department of Radiology, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - Abbas Mohamedali
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - Dennis Machaku
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
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3
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Vishnu J, Kapil N, Pe V, Patnaik P. Giant Colonic Lipoma Remains a Surgeon's Domain: A Report of Two Cases. Cureus 2023; 15:e43488. [PMID: 37719513 PMCID: PMC10499540 DOI: 10.7759/cureus.43488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Colonic lipomas are rare benign submucosal tumors that are mostly asymptomatic. With increasing size, they may develop symptoms and complications. The acute presentation may be intestinal obstruction secondary to intussusception or gastrointestinal bleeding. The chronic presentation may be subtle and mimic a colonic malignancy. Symptoms include altered bowel habits, abdominal pain, lower gastrointestinal bleeding, and weight loss. Diagnostic evaluation includes advanced imaging such as Computed Tomography, Magnetic Resonance Imaging, and Endoscopy. With the advent of endoscopic submucosal dissection techniques, the therapeutic capabilities of endoscopy have expanded over the decade. However, surgical interventions were reserved for large, symptomatic lipomas, and resection varies from segmental colonic resection to hemicolectomy. Size and clinical presentation determine the therapeutic approach. We, with this, report two cases of giant colonic lipoma in the right colon causing a colo-colic intussusception.
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Affiliation(s)
- Jaai Vishnu
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Nagaraj Kapil
- Surgical Gastroenterology, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Vaishnavi Pe
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Pooja Patnaik
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
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4
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Colonic lipomas revisited on CT colonography. Abdom Radiol (NY) 2022; 47:1788-1797. [PMID: 35303113 DOI: 10.1007/s00261-022-03489-2] [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: 01/01/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
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.
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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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6
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Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review. J Clin Med 2021; 10:jcm10215149. [PMID: 34768668 PMCID: PMC8584916 DOI: 10.3390/jcm10215149] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Results: Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm3. Conclusions: A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization.
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Moussally M, Mokalled I, Jamali F, Khalife MJ. Splenic flexure colonic lipoma causing intussusception. JRSM Open 2021; 12:2054270420983088. [PMID: 33489244 PMCID: PMC7804352 DOI: 10.1177/2054270420983088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Colonic lipomas are rare benign tumours that are usually asymptomatic. However, giant
colonic lipomas tend to be symptomatic and can occasionally result in intussusception and
intermittent colonic obstruction. As adult intussusception is an uncommon occurrence, the
identification of the underlying aetiology is essential due to its high association with
malignancy. Computed Tomography remains the tool of choice for the diagnosis of colonic
lipomas. Surgical excision remains the mainstay treatment of giant symptomatic colonic
lipomas. We hereby present the case of a 51-year-old male found to have a colonic lipoma
causing recurrent intussusception. We discuss the approach, diagnostic tools and available
treatment modalities for colonic lipomas. We also provide a brief literature review of
intussusception in adults.
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Affiliation(s)
- Moustafa Moussally
- Department of Surgery, American University of Beirut Medical Center, 1107 Beirut, Lebanon
| | - Imad Mokalled
- Department of Surgery, American University of Beirut Medical Center, 1107 Beirut, Lebanon
| | - Faek Jamali
- Department of Surgery, American University of Beirut Medical Center, 1107 Beirut, Lebanon
| | - Mohamad J Khalife
- Department of Surgery, American University of Beirut Medical Center, 1107 Beirut, Lebanon
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Abstract
RATIONALE Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma. PATIENT CONCERNS A 27-year-old woman complaints of intermittent abdominal pain for 10 days. DIAGNOSIS Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made. INTERVENTIONS The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed. OUTCOMES Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications. LESSONS We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.
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Affiliation(s)
- Chunyu Shi
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
| | - Lu Pan
- Department of Pediatric Immunology, Allergy and Rheumatology, The No.1 Hospital of Jilin University
| | - Bin Song
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
| | - Yongjian Gao
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
| | - Leichao Zhang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ye Feng
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
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9
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Siamionava Y, Varabei A, Makhmudov A. Recurrent colonic intussusception due to a lipoma of the transverse colon at the background of congenital dolichocolon and chronic constipation. BMJ Case Rep 2019; 12:12/8/e230732. [PMID: 31471364 DOI: 10.1136/bcr-2019-230732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Colonic intussusception caused by benign tumour in adults is uncommon condition. Lipoma as benign tumour arises from submucosal layer of gastrointestinal tract and derives from mature adypocytes. It is usually small asymptomatic lesion and reveals during colonoscopy, CT, surgery or autopsy accidentally. However, in cases with large size it may cause abdominal pain, constipation, diarrhoea, anaemia, bleeding or intussusceptions. We present a 52-year-old female patient with colonic intussusception caused by lipoma of the transverse colon and with congenital dolichocolon. The patient had several episodes of bowel obstructions which were treated conservatively. We performed elective open extended right hemicolectomy, ileotransversostomy end-to-end.
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Affiliation(s)
- Yuliya Siamionava
- Surgery, Belarussian Medical Academy of Posrtgraduate Education, Minsk, Belarus.,Proctology, Minsk Regional Hospital, Minsk, Belarus
| | - Aliaksandr Varabei
- Surgery, Belarussian Medical Academy of Posrtgraduate Education, Minsk, Belarus
| | - Anvar Makhmudov
- Minimally Invasive Surgery, 2nd Minsk City Clinical Hospital, Minsk, Belarus
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10
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Garzón-Olarte HH, Holguín-Henao JG, Padilla-Herrera CJ, Baquero-Zamara DR. Colonic intussusception as a rare manifestation of colonic lipoma: Case report. CASE REPORTS 2019. [DOI: 10.15446/cr.v5n2.77647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Colonic lipomas are low-risk lesions that require endoscopic or surgical management depending on their size and symptoms. However, diagnosing a lipomatous lesion in the colon is a difficult task, as the clinical or imaging findings point to a low prevalence of these lesions and a higher frequency in the female sex. The laparoscopic approach is the current method of choice as it represents fewer traumas and, therefore, a faster clinical recovery.Case presentation: 43-year-old female patient, Caucasian, from the city of Bogotá, housewife, without any medical history. She presented with acute abdominal pain associated with tarry stools. Diagnostic imaging tests were performed, finding colo-colonic intussusception, originated in a lipomatous lesion located in the transverse colon. This patient underwent an enlarged laparoscopic right hemicolectomy.Discussion: This case describes how colonic intussusception constitutes a preoperative complication that requires surgical management since its diagnosis considering the associated mortality rates.Conclusion: The analysis of this case is part of the scientific evidence indispensable to improve the diagnostic and therapeutic approach to colonic intussusception, as local and international literature have not addressed this condition sufficiently.
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11
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Alshoabi SA, Abdulaal OM. An unusual case of colonic intussusception in old age. J Taibah Univ Med Sci 2019; 14:199-202. [PMID: 31435410 PMCID: PMC6694946 DOI: 10.1016/j.jtumed.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Sultan A. Alshoabi
- Department of Diagnostic Radiologic Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, KSA
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12
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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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Nonsyndromic Intestinal Lipomas are Probably not Associated With Mutations of PDGFRA. Appl Immunohistochem Mol Morphol 2018; 25:664-667. [PMID: 26990750 DOI: 10.1097/pai.0000000000000356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to test the hypothesis that intestinal lipomas occurring in patients devoid of signs of PDGFRA-mutant syndrome might represent sporadic counterparts of familial lipomatous tumors occurring in the spectrum of tumors associated with PDGFRA mutations. PDGFRA-mutant syndrome may manifest with gastrointestinal stromal tumors, Vanek tumors, fibrous tumors, and lipomatous tumors. Until now there has been no molecular genetic study of PDGFRA mutations in intestinal lipomas published in the world literature. A series of 20 intestinal lipomas were obtained from 17 patients, and mutational analysis of exons 12, 14, and 18 of the PDGFRA gene was performed. None of the 16 analyzable tumors showed mutations in PDGFRA. Thus, PDGFRA mutations probably do not play an important role in the development of sporadic lipomas of the intestines.
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14
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Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes. J Clin Imaging Sci 2017; 7:15. [PMID: 28480123 PMCID: PMC5404618 DOI: 10.4103/jcis.jcis_6_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/01/2017] [Indexed: 12/18/2022] Open
Abstract
Although large bowel obstruction (LBO) is less common than small bowel obstruction, it is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. Plain radiographs are sufficient to diagnose LBO in a majority of patients. However, further evaluation with multidetector computed tomography (MDCT) has become the standard of care to identify the site, severity, and etiology of obstruction. In this comprehensive review, we illustrate the various causes of LBO emphasizing the role of MDCT in the initial diagnosis and detection of complications along with the tips to differentiate from disease which can mimic LBO.
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Affiliation(s)
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Ravi Vassa
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Arpit Nagar
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
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15
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Intestinal Obstruction Caused by Ileocolic and Colocolic Intussusception in an Adult Patient with Cecal Lipoma. Case Rep Surg 2017; 2016:3519606. [PMID: 28044120 PMCID: PMC5164886 DOI: 10.1155/2016/3519606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction. Intussusception is a rare clinical entity in adults (<1% of intestinal obstructions). Colonic intussusception is even rarer, particularly when caused by lipomas. Case Presentation. A 47-year-old woman presented to our emergency department complaining of abdominal pain with vomiting and diarrhoea. X-ray and CT showed bowel obstruction due to ileocolonic and colocolonic intussusception; a giant colonic lipoma (9 × 4 × 4 cm) was recognizable immediately distally to the splenic flexure of the colon. The patient underwent emergency laparotomy and right hemicolectomy. Assessment of the resected specimen confirmed the diagnosis of giant colonic polypoid lesion near to the ileocecal valve, causing a 12 cm long intussusception with moderate ischemic damage. Conclusion. Colonic obstruction due to intussusception caused by lipomas is a very rare condition that needs urgent treatment. CT is the radiologic modality of choice for diagnosis (sensitivity 80%, specificity near 100%); since the majority of colonic intussusceptions are caused by primary adenocarcinoma, if the etiology is uncertain, the lesion must be interpreted as malignant and extensive resection is recommended. At present, surgery is the treatment of choice and determines an excellent outcome.
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16
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González-Urquijo M, Kettenhofen SE, Rodarte-Shade M. Colonic intussusception by a giant colon lipoma: A case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2017. [DOI: 10.1016/j.ijso.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Bagherzadeh Saba R, Sadeghi A, Rad N, Safari MT, Barzegar F. Colonic intussusception in descending colon: An unusual presentation of colon lipoma. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2016; 9:S93-S96. [PMID: 28224035 PMCID: PMC5310807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Lipomas of the colon are relatively rare benign soft tissue tumors derived from mature adipocytes of mesenchymatic origin. During colonoscopy, surgery or autopsy they are generally discovered incidentally. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, in the cases with larger in size of tumor some symptoms such as anemia, abdominal pain, constipation, diarrhea, bleeding, or intussusception may be presented. We reported a 47-year-old woman with colonic intussusception in the descending colon caused by colonic lipoma and diagnosed after surgical exploration for obstructive colonic mass.
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Affiliation(s)
- Reza Bagherzadeh Saba
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Rad
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research institute for Gastroenterologyand Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Safari
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnoush Barzegar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Wang Y, Gowing S, Arena G. Adult colo-colonic intussusception caused by congenital bands: A case report and literature review. Int J Surg Case Rep 2016; 26:88-92. [PMID: 27475114 PMCID: PMC5010636 DOI: 10.1016/j.ijscr.2016.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/02/2016] [Accepted: 07/17/2016] [Indexed: 12/27/2022] Open
Abstract
Adult colo-colonic intussusception is predominantly associated with a pathologic lead point. First description of adult colo-colonic intussusception caused by congenital bands. Treatment typically involves en-bloc resection due to concern of malignancy. Laparoscopic techniques are safe, feasible, and may enhance recovery.
Introduction Intussusception refers to the telescoping of a segment of bowel into the lumen of an adjacent segment. While pediatric intussusception is common and generally idiopathic, adult intussusception is exceedingly rare and is usually attributable to a pathologic lead point. Presentation of case 37-year-old man who presented with abdominal pain, and was preoperatively diagnosed with a colo-colonic intussusception. Intraoperatively, the lead point was found to be congenital bands, and there was no evidence of underlying malignancy. He underwent a laparoscopic-assisted extended right hemicolectomy with side-to-side ileo-colic anastomosis. Discussion Colo-colonic intussusception is a rare cause of intestinal obstruction in adults. Patients generally present with subacute abdominal pain and obstructive symptoms, rendering the clinical diagnosis challenging. Computed tomography has been shown to be the most accurate diagnostic imaging modality. Due to the high incidence of underlying malignancy in adult colo-colonic intussusception, en-bloc resection of the involved bowel segment remains the standard of care. Conclusion Congenital bands can serve as a lead point in colo-colonic intussusception, particularly in younger adults. Prompt surgical intervention remains paramount to limit morbidity.
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Affiliation(s)
- Yifan Wang
- Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephen Gowing
- Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Goffredo Arena
- Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
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Clinical and Ultrasonographic Features of Secondary Intussusception in Children. Eur Radiol 2016; 26:4329-4338. [PMID: 27048536 DOI: 10.1007/s00330-016-4299-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/01/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Ghanem OM, Slater J, Singh P, Heitmiller RF, DiRocco JD. Pedunculated colonic lipoma prolapsing through the anus. World J Clin Cases 2015; 3:457-461. [PMID: 25984520 PMCID: PMC4419109 DOI: 10.12998/wjcc.v3.i5.457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal lipomas are the second most common benign tumors of the colon. These masses are typically incidental findings with over 94% being asymptomatic. Symptoms-classically abdominal pain, bleeding per rectum and alterations in bowel habits-may arise when lipomas become larger than 2 cm in size. Colonic lipomas are most often noted incidentally by colonoscopy. They may also be identified by abdominal imaging such as computed tomography or magnetic resonance imaging. We report a case of a sixty-one years old male who presented to our emergency room with a 6.7 cm × 6.3 cm soft tissue mucosal mass protruding transanally. The patient was stable with a benign abdominal examination. The mass was initially thought to be a rectal prolapse; however, a limited digital rectal exam was able to identify this as distinct from the anal canal. Since the mass was irreducible, it was elected to be resected under anesthesia. At surgery, manipulation of the mass identified that the lesion was pedunculated with a long and thickened stalk. A laparoscopic linear cutting stapler was used to resect the mass at its stalk. Pathology showed a polypoid submucosal lipoma of the colon with overlying ulceration and necrosis. We report this case to highlight this rare but possible presentation of colonic lipomas; an incarcerated, trans-anal mass with features suggesting rectal prolapse. Trans-anal resection is simple and effective treatment.
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