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Bokhari SFH, Yaseen K, Abid S, Vohra RR, Sajid S. Ileocecal Intussusception With Lipoma as a Lead Point Leading to Small Bowel Obstruction in an Elderly Male: A Case Report. Cureus 2022; 14:e28919. [PMID: 36237737 PMCID: PMC9547125 DOI: 10.7759/cureus.28919] [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] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Amirhom E, Dondapati M, Horton N, Pescovitz AR. Large colonic lipoma as a lead point for intussusception in an adult. J Surg Case Rep 2022; 2022:rjac327. [PMID: 35854819 DOI: 10.1093/jscr/rjac327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Emad Amirhom
- Department of Surgery, NYC Health and Hospitals/Queens, New York, USA
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Busa V, Bandaru SS, Mahat R, Janga C. A Rare Case of Colo-Colonic Intussusception Caused by Colonic Submucosal Lipoma. Cureus 2022; 14:e23600. [PMID: 35371854 PMCID: PMC8973248 DOI: 10.7759/cureus.23600] [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] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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A large lipoma of the descending colon: A rare case report. Radiol Case Rep 2021; 16:3396-3399. [PMID: 34504632 PMCID: PMC8416966 DOI: 10.1016/j.radcr.2021.08.013] [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: 08/03/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Colon lipoma is a rare benign disease in the gastrointestinal tract with an incidence rate of approximately 0.035%-4.4%. The disease is often asymptomatic, so it is frequently discovered incidentally through endoscopy, computed tomography , or autopsy. When the tumor is over 2 cm in size, symptoms such as abdominal pain, bowel disorders, and bowel obstruction are common. Surgery is considered the mainstay of treatment for colonic lipomas. Furthermore, surgical (rather than endoscopic) resection is preferred for lipomas >2 cm to avoid complications such as bleeding and perforation. We report on a 61-year-old female patient who was diagnosed with a 4-cm descending colonic fat tumor detected by endoscopy and computed tomography and confirmed by pathology.
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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M'rabet S, Jarrar MS, Akkari I, Abdelkader AB, Sriha B, Hamila F, Letaief R, Jazia EB. Colonic intussusception caused by a sigmoidal lipoma: A case report. Int J Surg Case Rep 2018; 50:1-4. [PMID: 30059860 PMCID: PMC6079477 DOI: 10.1016/j.ijscr.2018.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/20/2018] [Indexed: 12/14/2022] Open
Abstract
Intestinal intussusception in adults is rare, accounting for approximately 1% of all bowel obstructions. Colo-colonic intussusception accounts for 17% of cases. The occurrence of large lipomatous masses as cause of intussusception and semi-obstructive symptoms remains rare. The case that we describe is particularly unique because apart from being an example of intussusception in adults, it occurred in the sigmoid colon and was not associated with a malignant lesion.
Introduction Intussusception is a relatively common condition seen in children. In comparison, adult intussusception is rare and is often secondary to inflammatory diseases, benign or malignant tumors and motility disorders. Being a benign cause, lipomas appear as a particularly rare gastrointestinal tumor. Presentation of Case We present a case of colo-colonic intussusception secondary to a sigmoidal lipoma, in a 40-year-old man. We describe the different aspects of diagnosis and management of this rare complication. Discussion Adult intussusception is the cause of symptomatic bowel obstruction in 1% of cases and its colo-colonic occurrence represents 17% of all intestinal intussusceptions. The case that we describe is particularly unique because apart from being an example of intussusception in adults, it occurred in the sigmoid colon and was not associated with a malignant lesion. The treatment of intussusception in adults is surgical resection because of the high incidence of underlying malignancy. Colonoscopy is a modality which allows direct visualization of the lipoma. However, intraluminal reduction via colonoscopy is not recommended. Conclusion Colo-colonic intussusception is a very rare complication of lipoma. It is determined that the treatment is surgical due to the risk of malignancy.
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Affiliation(s)
- Soumaya M'rabet
- Department of Gastroenterology, Farhat Hached University Hospital, Sousse, Tunisia.
| | | | - Imen Akkari
- Department of Gastroenterology, Farhat Hached University Hospital, Sousse, Tunisia
| | | | - Badreddine Sriha
- Department of Anatomical Pathology University Hospital, Sousse, Tunisia
| | - Fahmi Hamila
- Department of Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rached Letaief
- Department of Surgery, Farhat Hached University Hospital, Sousse, Tunisia
| | - Elhem Ben Jazia
- Department of Gastroenterology, Farhat Hached University Hospital, Sousse, Tunisia
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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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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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Jiang RD, Zhi XT, Zhang B, Chen ZQ, Li T. Submucosal Lipoma: a Rare Cause of Recurrent Intestinal Obstruction and Intestinal Intussusception. J Gastrointest Surg 2015; 19:1733-5. [PMID: 25895980 DOI: 10.1007/s11605-015-2824-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/08/2015] [Indexed: 01/31/2023]
Abstract
Intestinal lipomas are rare nonepithelial tumors that are usually detected incidentally. They are usually asymptomatic, but lipomas larger than 2 cm may become symptomatic due to obstruction, bleeding, or intussusception. Adult intussusception due to intestinal lipoma is a very rare condition. In this paper, we report a case of small bowel lipoma that became symptomatic due to intermittent obstruction episodes and ileo-ileal intussuception. Segmental ileal resection was performed, and histopathological examination of the resected specimen confirmed the diagnosis of lipoma.
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Affiliation(s)
- Run-De Jiang
- Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
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Mohamed M, Elghawy K, Scholten D, Wilson K, McCann M. Adult sigmoidorectal intussusception related to colonic lipoma: A rare case report with an atypical presentation. Int J Surg Case Rep 2015; 10:134-7. [PMID: 25839433 PMCID: PMC4430077 DOI: 10.1016/j.ijscr.2015.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 11/19/2022] Open
Abstract
Intussusception is rare in adults. Lipoma of the sigmoid colon is rare. 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. CT scan is an excellent diagnostic modality for adult intussusception. 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.
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Affiliation(s)
- Mohamed Mohamed
- Trauma Services Department, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503, USA.
| | - Karim Elghawy
- Trauma Services Department, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503, USA
| | - Donald Scholten
- Trauma Services Department, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503, USA
| | - Kenneth Wilson
- Trauma Services Department, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503, USA
| | - Michael McCann
- Trauma Services Department, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503, USA
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