Ileocolic intussusception caused by a lipoma in an adult

Adult Ileocolic Intussusception Secondary to Cecal Lipoma: A Case Report

Large intestinal intussusception is rare in adults. Among potential pathologic lead points for intussusception are lipomas, benign tumors very infrequently found in the large bowel. A 30-year-old woman presented to the emergency department with a chief complaint of generalized abdominal pain for two weeks. A computed tomography scan of her abdomen and pelvis showed an ileocolic intussusception with a lead point of 6.7 cm. The lead point appeared to be predominantly fat. A colonoscopy revealed a large, obstructing lesion in the transverse colon. The patient underwent exploratory laparotomy with a right hemicolectomy, and a pathologic diagnosis of a lipoma was made. The patient recovered from surgery without complications and returned to her normal diet three weeks after discharge. This case highlights an unusual and rare presentation of an ileocolic intussusception caused by a cecal lipoma acting as a lead point.

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.

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.

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.

Laparoscopic ileo-cecectomy for ileo-ceco-colic double intussusception due to a cecal adenoma harboring multifocal high grade dysplasia in a 24 years old male: A case report

•

Bowel intussusception is defined as invagination of the intussusceptum into the intussuscepien.

•

Responsible of 1% of all bowel obstructions.

•

Colonic involvement is majorly due to malignant lesions.

•

Colonoscopy has a role in diagnosing the cause and location of leading point, as well as non-operative reduction in selected cases.

•

Oncological surgical resection is the most agreeable definitive treatment method.

Introduction

Intestinal Intussusception is defined as invagination of the intussusceptum into the intussuscepien, and is responsible of 1% of all bowel obstructions. It is rare in adults and common in children. It is mostly due to organic causes in adults that form lead points. Enteroenteric intussusception is the most common type. Signs and symptoms are more classic in children but nonspecific in adults. Usually diagnosis is made intraoperatively, while abdomino-pelvic CT scan is the best preoperative imaging modality. Intestinal Intussusception in adults, especially when the colon is involved, is best treated by surgical resection.

Case presentation

A 24 years old previously healthy male with no surgical or documented familial history presenting for severe crampy abdominal pain and distention, obstipation and palpable right lower quadrant abdominal mass. Abdominal Multi-slice CT diagnosed an ileo-colic intussusception without signs of bowel suffering. Laparoscopic ileo-cecetomy. Final Pathology showed a 4 cm cecal tubular adenomatous polyp with multifocal high grade dysplasia.

Conclusion

Intestinal intussusception in adults is an interesting rare entity that have the interest of general surgeons. Malignant lesions can be lead-points and they form a great counterpart among other colonic lesions. Minimally invasive laparoscopic surgery is gaining interest in management, and surgical resection remains the gold standard while reduction before surgery is debatable and can be considered in selected cases.

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.

Ileocolic intussusception caused by ileal lipoma: A case report

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.

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.