Idiopathic adult intussusception

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.

Submucosal Lipoma Causing Small Bowel Intussusception

Intussusception involves telescoping of one segment of the intestine into an adjacent segment. Although this diagnosis is common in the pediatric population, it is much less common in adults. One of the main reasons it may occur in adults is due to a mass. Intestinal masses can be malignant, such as gastrointestinal stromal tumors, lymphomas, or adenocarcinomas; or they can be benign. One benign lead point in intussusception is a lipoma. A lipoma usually presents on the trunk, neck, or forearm, but can rarely be seen in the gastrointestinal tract. When it presents in the intestine, it can be either asymptomatic or it can be symptomatic and causes abdominal pain, nausea, vomiting, and gastrointestinal bleeding. Furthermore, it may act as a lead point and causes intussusception. We present an adult patient with two rare findings: small bowel obstruction from intussusception caused by a benign intestinal lipoma as its lead point. The patient was promptly taken to the operating room, where the intussuscepted bowel was resected along with the lipoma, and the patient had an uncomplicated recovery. The pathology report confirmed the specimen to be a submucosal lipoma with mature adipose tissue without atypia. Although intussusception and intestinal lipomas are both rare in adults, it is important to be aware of them on the list of differential diagnoses in adult patients with abdominal pain. This is because it can cause a wide array of complications including, ischemia, bowel perforation, sepsis, shock, and peritonitis. The lead point in intussusception has the possibility of being malignant. Careful consideration of these diagnoses with prompt imaging and appropriate intraoperative management is vital for good patient outcomes.

Colorectal intussusception due to adenocarcinoma presenting as acute bowel obstruction in an adult

Colorectal intussusception is a rare entity in adults presenting an acute abdomen. The authors present a case of a 73-year-old female who presented with an acute large bowel obstruction. Abdominal computed tomography (CT) scan reveals a colorectal intussusception with a colonic distension upstream. Laparoscopy founds out a stenotic tumor on colorectal junction corresponding with an adenocarcinoma on histopathological exam. CT scan is the most specific diagnostic test for intussusception and is superior to ultrasonography and endoscopy and thus should be performed preferentially.

Idiopathic adult intestinal intussusception: a rare cause of an acute surgical abdomen

Intussusception is uncommon among adults. The condition, which is defined as a telescoping of a proximal portion of the small or large bowel into the lumen of an adjacent segment of bowel, is most commonly seen in children. Among pediatric cases, the majority is benign and treated non-operatively. However, in adults, intussusception is the result of pathologic and often malignant lead points in the majority of cases. This makes surgical resection and tissue diagnosis the only definitive treatment option. While the majority of adult intussusception cases involves a pathologic lead point, a small percentage is idiopathic, without an identifiable lead point. We present a 32-year-old man with acute on chronic abdominal pain and cross-sectional imaging that identified jejunal intussusception, which was confirmed in operating room and resected. Interestingly, no pathologic lead point was identified on pathologic review. We discuss our diagnostic approach, surgical decision making and final tissue diagnosis.

Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.

Massive Lipomatosis of the Small Intestine Causing Intussusception

Lipomatosis is a rare condition characterized by diffuse, unencapsulted adipose tissue deposition. Intestinal involvement is rare, and presentation as intussusception is rarer still. We report a 40-year-old man who presented with abdominal pain and fecal urgency. Abdominal CT scan showed a protuberant ileo-cecal valve, with intussusception of the ileum into the cecum. The mucosal surface of the resected bowel was bulbous and protuberant, showing loss of mucosal folds, and there was an 8 × 5 × 5 cm mass prolapsing into the ileo-cecal valve. Microscopically there was abundant adipose tissue in the submucosa with an unremarkable mucosa. The patient recovered uneventfully with only occasional cramping in the left abdomen.

Adult sigmoidorectal intussusception related to colonic lipoma: A rare case report with an atypical presentation

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Intussusception is rare in adults.

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Lipoma of the sigmoid colon is rare.

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Colonic lipoma should be considered in the differential diagnosis of adults with intussusception with high index of suspicion for obstruction when lipoma is >2 cm.

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CT scan is an excellent diagnostic modality for adult intussusception.

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Surgical reduction followed by resection leads to excellent results in adults diagnosed with sigmoidorectal intussusception secondary to colonic lipoma.

Introduction

Adult intussusception is rare. Lipoma is the second most common benign tumor of the colon and most common to cause colonic intussusception in adults, but rare.

Presentation of case

A 35-years-old male presented with a history of intermittent abdominal pain and bright red rectal bleeding, with symptoms waxing and waning for one month. On physical examination, the abdomen was distended with tenderness over the periumbilical, suprapubic, and left lower quadrant regions with guarding. CT demonstrated colo-colonic intussusception of the sigmoid colon with a 2.3 cm × 2.6 cm intra-mural lipoma of the rectosigmoid region. The patient underwent an exploratory laparotomy with partial reduction of the intussusception, sigmoid colon resection and end colostomy. Histopathology confirmed a 2.5 cm sub-mucosal lipoma without evidence of malignancy.

Discussion

Sixty–sixty five percent of cases with intussusception of the large bowel in adults are related to a malignant etiology and most cases of sigmoidorectal intussusception reported in the literature are secondary to underlying malignancy. Colo-colic intussusception is the most common type of intussusception in adults. The incidence of lipomas of the large intestine is reported to range from 0.035% to 4.4%. Ninety percent of colonic lipomas are submuscosal and are mostly located in the right hemicolon. Only 25% of patients with colonic lipoma develop symptoms. Colonic lipomas of the rectosigmoid region represent a very rare occurrence and subsequent etiology for sigmoidorectal intussusceptions in adults.

Conclusion

Colonic lipoma should be considered in the differential diagnosis of adults with intussusception, with reduction and resection leading to excellent results.

Adult colonic intussusception: Surgery still the best option

Intussusception is the telescoping of proximal bowel wall into the lumen of a distal segment. Whilst it is common in children, intussusception in adults is rare, and predominantly occurs secondary to an underlying malignant neoplasm. Abdominal and pelvic computed tomography (CT) is preferred for detection of lead points and lesion localisation. We present the case of a 79-year-old female with a four-day history of colicky abdominal pain followed by obstipation and distension. CT demonstrated a rounded heterogeneous density protruding into the upper rectal lumen, and also left-sided colonic obstruction. Emergency laparotomy revealed a mid-sigmoid colonic mass intussuscepting into the rectum. Histopathology confirmed a T3N1 moderately differentiated colonic adenocarcinoma. Given the high likelihood of underlying malignancy, surgical reduction of the intussusceptum may be complicated by perforation and tumour spillage. En bloc resection using oncologic surgical principles remains the first line treatment.