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Ayadi TY, Behi H, Guelmami H, Changuel A, Tlili K, Khalifa MB. Colo-colonic intussusception secondary to giant colonic lipoma in an adult: A case report. Int J Surg Case Rep 2024; 121:109920. [PMID: 38908161 PMCID: PMC11252928 DOI: 10.1016/j.ijscr.2024.109920] [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: 05/16/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Intestinal intussusception is a rare complication in adults, accounting for 1 % of intestinal obstructions. Unlike in children, it is often secondary to a malignant lesion, rarely a benign one. Colonic lipomas are asymptomatic benign tumors often discovered incidentally. Colo-colonic intussusception due to a lipoma is exceptional. Here, we report a rare case of colo-colonic intussusception secondary to a giant caecal lipoma occurring in a 65-year-old woman. CASE PRESENTATION A 65-year-old woman, was admitted in our surgical department for intermittent crampy abdominal pain in the right iliac fossa with an alternation of diarrhea and constipation over the past 10 months. The radiological investigation revealed a colo-colonic intussusception, most likely secondary to a fatty mass in the cecum. A right hemicolectomy was performed with ileocolic anastomosis because of the risk of malignancy. Histopathological examination confirmed the lipomatous nature of the lesion. The patient remained asymptomatic three years after surgery. CLINICAL DISCUSSION Colonic lipomas are often asymptomatic. They can cause intussusception with clinical symptoms varying based on their size and location. CT scan has increased the number of preoperative diagnoses. Treatment options include surveillance, endoscopic intervention, or surgical resection. The appropriate surgical intervention remains a major challenge for surgeons due to the risk of malignancy. CONCLUSION A giant colonic lipoma remains a very rare cause of colonic intussusception, especially in adults. CT scan plays a crucial role in diagnosis. Surgical resection remains the treatment of choice due to the risk of malignancy.
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Affiliation(s)
- Taha Yassine Ayadi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
| | - Hager Behi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Hanene Guelmami
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Amel Changuel
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Karima Tlili
- Pathology Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Mohamed Bachir Khalifa
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
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Bouzid A, Belhadj A, Khefacha F, Touati MD, Saidani A, Chebbi F. A laparoscopic odyssey: Managing giant colonic lipoma-induced colo-colonic intussusception - A case report. Int J Surg Case Rep 2024; 119:109780. [PMID: 38776821 PMCID: PMC11141433 DOI: 10.1016/j.ijscr.2024.109780] [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: 03/24/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Colonic lipomas (CL) are rare non-epithelial benign tumors. Giant Colonic lipomas (>4 cm) can cause serious complications such as bowel obstruction, massive bleeding, perforation, and intussusception. Early diagnosis is difficult and preoperative discrimination between malignant lesions and large cl is challenging. Surgical resection is the cornerstone of the treatment. CASE PRESENTATION A 57-year-old woman presented to our surgical department complaining about intermittent crampy abdominal pain with an alternation of diarrhea and constipation for the last 7 months. After radiological and endoscopic investigations, the diagnosis of colo-colonic intussusception caused by colonic lipoma was confirmed. The patient underwent laparoscopic enucleation and a histopathological examination of the specimen confirmed the diagnosis of colonic lipoma. DISCUSSION Colonic lipomas (CL), though rare (0.2 to 4 %), are the third most common benign colon tumors. Typically affecting adult women (57 %), these non-epithelial growths can vary in size from 2 mm to 30 cm, often remaining asymptomatic until complications arise. Colonic lipomas may lead to intussusception or bowel obstruction, with clinical presentation depending on size and location. Diagnosis relies on abdominal CT scans or MRI, while treatment options include surveillance, endoscopic, or surgical resection. Laparoscopic approaches offer favorable postoperative outcomes, although precise localization remains a challenge. Endoscopic techniques are limited, particularly for larger or difficult-to-access lipomas, necessitating expert care. CONCLUSION Giant colonic lipoma can cause colonic intussusception leading to emergency operation. We think that laparoscopic enucleation seems to be the ideal treatment choice, especially when the malignancy cannot be excluded.
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Affiliation(s)
- Ahmed Bouzid
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Fahd Khefacha
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
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Nematihonar B, Mohajerzadeh L, Jouzdani T, Khoshnoudi H, Kouchak Hosseini SP, Haghbin Toutounchi A. Colocolic intussusception due to lipoma in an adolescent with refractory anal fissure; case report and literature review. Int J Surg Case Rep 2024; 119:109759. [PMID: 38759399 PMCID: PMC11127530 DOI: 10.1016/j.ijscr.2024.109759] [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: 04/26/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intussusception is uncommon in older patients, making its diagnosis challenging and necessitating a high level of clinical suspicion. While pediatric intussusception typically presents with a triad of symptoms including abdominal pain, bloody diarrhea, and an abdominal mass, the majority of adult patients experience chronic abdominal pain and partial obstruction. Consequently, the diagnosis of adult intussusception may be delayed due to the similarity in presentation with other conditions. CASE PRESENTATION In this article, we have presented a 13-year-old boy with chronic and refractory anal fissure. The patients also complained of constipation for a year, intermittent abdominal pain, and bloating. Although he was treated with conservative laxative medications, the constipation was not relieved. Incidentally, a colocolic intussusception was found through an MRI. CLINICAL DISCUSSION We have provided a comprehensive description of an unexpected intussusception at an uncommon age which was found incidental. Medical literature was reviewed for better optimal planning in surgery. CONCLUSION Intussusception in a teenager is unexpected, and this case shows the importance of considering it even in the presence of nonspecific symptoms. This case serves as a reminder to healthcare professionals to consider intussusception as a potential diagnosis in similar cases.
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Affiliation(s)
- Behzad Nematihonar
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leily Mohajerzadeh
- Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahmaseb Jouzdani
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hojatolah Khoshnoudi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Pedram Kouchak Hosseini
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Dong QJ, Tang Y, Zhang CL, Li XG, Chen X, Wang Y. Role of clinical and multidetector computed tomography (MDCT) features in the prediction of patients with intestinal lipoma developing intussusception. Quant Imaging Med Surg 2024; 14:3939-3950. [PMID: 38846289 PMCID: PMC11151265 DOI: 10.21037/qims-23-1530] [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: 10/29/2023] [Accepted: 04/17/2024] [Indexed: 06/09/2024]
Abstract
Background Intestinal lipoma is considered the most common benign tumor that causes intussusception. This retrospective case-control study aimed to present the clinical and multidetector computed tomography (MDCT) features between intestinal lipomas with and without intussusception and examine risk factors that predict intussusception caused by intestinal lipomas. Methods We retrospectively analyzed 281 adult patients diagnosed with intestinal lipoma by radiologists using whole-abdominal MDCT between January 2015 and August 2022. Patients were divided into adult intussusception (AI) and non-AI groups based on MDCT images. Univariate logistic regression was performed to identify risk factors for intestinal lipoma-induced intussusception. Results A total of 281 patients with intestinal lipomas were included in the study, with an average age of 68.0±11.3 years, and the male to female ratio was about 1:1.4. Among them, 24 patients developed lipoma-induced intussusception. Patients in the AI group presented with more abdominal pain (70.8% vs. 47.1%, P=0.03), nausea/vomiting (37.5% vs. 14.8%, P=0.009), hematochezia/melena (29.2% vs. 11.3%, P=0.02), and abdominal tenderness (66.7% vs. 24.9%, P<0.001). Lipomas were more common in the small bowel (224/281, 79.7%) than the large bowel (57/281, 20.3%). Lipomas in the AI group showed more heterogeneous hypodensity (41.7% vs. 15.6%, P=0.004), longer length (median, 2.2 vs. 1.2 cm, P<0.001), and larger volume (median, 4.1 vs. 0.6 cm3, P<0.001). In the univariate logistic regression, lipoma density [odds ratio (OR) =3.875, 95% confidence interval (CI): 1.609-9.331, P=0.003] and lipoma length (OR =3.216, 95% CI: 1.977-5.231, P<0.001) were risk factors for intestinal lipoma-induced intussusception. Conclusions More patients in the AI group have digestive tract symptoms than those in the non-AI group. Lipoma density and length are risk factors for intussusception in patients with intestinal lipoma. In addition, the common site of intestinal lipoma may have changed from the colon to the small intestine.
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Affiliation(s)
- Qiu-Jie Dong
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Tang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Chun-Lai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Guang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao Chen
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Wang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
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Kumar S, Harisankar AG, Singh R, Kumar A, Kumar B, Mandal M. Lipoma of the gastrointestinal tract: a tertiary care centre experience. Ann R Coll Surg Engl 2024; 106:401-406. [PMID: 37823391 PMCID: PMC11060862 DOI: 10.1308/rcsann.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Gastrointestinal (GI) lipomas are rare; however, they are frequent enough to be considered in the differential diagnosis of gut tumours. Here, we present our experience with GI lipomas managed at our institute over the last three years. METHODS This is a retrospective cohort study of patients with GI lipomas managed between January, 2020 and April, 2023 at a tertiary care centre. Clinical presentation, location, and details of surgical procedure were analysed. RESULTS Ten patients were included, six of whom had lipoma in the colon, one in the stomach, and one each in the duodenum, jejunum, and ileum. The mean age at the time of presentation was 48.8 years (range, 19-77 years), and strong male preponderance (4:1) was noted. Preoperative diagnosis of lipoma on cross-sectional imaging was possible in all patients. All patients were symptomatic and were managed surgically. CONCLUSIONS While GI lipomas are generally considered to be indolent and benign tumours, they can potentially lead to severe complications. The utilisation of computed tomography and magnetic resonance imaging has brought about a significant transformation in diagnosing this condition, enabling preoperative identification in most cases. The surgery offers a definitive treatment with minimal risk of postoperative complications.
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Affiliation(s)
- S Kumar
- Indira Gandhi Institute of Medical Sciences, India
| | | | - R Singh
- Indira Gandhi Institute of Medical Sciences, India
| | - A Kumar
- BIG Apollo Spectra Hospitals, India
| | - B Kumar
- Sri Krishna Medical College and Hospital, India
| | - M Mandal
- Indira Gandhi Institute of Medical Sciences, India
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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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7
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Yu HW, Yan JG, Zheng L, Huang JH. Ileum intussusception secondary to submucosal liposarcoma in adult:A case report. Heliyon 2024; 10:e23432. [PMID: 38192766 PMCID: PMC10772086 DOI: 10.1016/j.heliyon.2023.e23432] [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: 04/13/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Intussusception in adults is a rare surgical emergency. Unlike in children, most adult intussusceptions arise from a pathological lead point. Ileal intussusception caused by a submucosal liposarcoma is a particularly rare phenomenon. This report describes the diagnosis and management of adult ileal intussusception secondary to submucosal liposarcoma in adult to provide a reference for future clinical work. A 64-year-old female presented to the emergency department with worsening abdominal pain associated with an 8 h history of intermittent vomiting. Based on physical examination, laboratory investigations, and computed tomography, the most likely diagnosis was ileal intussusception secondary to liposarcoma. Thus, emergency laparotomy was performed. During exploration, an ileal invagination was visualised approximately 30 cm from the ileocecal valve, and a flexible polypoid mass was palpable at the lead point of the intussusception. Subsequently, the patient underwent radical resection of pathological tissues with a primary end-to-end ileal anastomosis. Histopathological examination revealed a well-differentiated submucosal liposarcoma. Postoperatively, the patient recovered uneventfully and was doing well at the 6-month follow-up in the outpatient clinic. Thus, clinicians should consider the origin of submucosal liposarcomas in adult with intussusception. Once ileal intussusception secondary to submucosal liposarcoma is diagnosed, timely radical resection is recommended.
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Affiliation(s)
- Hong-wei Yu
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Jin-gang Yan
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Lei Zheng
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Jun-hua Huang
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
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8
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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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Kyaw PSP, Eliezer DD, Sutherland A. Colo-colonic intussusception secondary to a lipomatous lesion in an asymptomatic patient. BMJ Case Rep 2023; 16:e256128. [PMID: 37848278 PMCID: PMC10583061 DOI: 10.1136/bcr-2023-256128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Colo-colonic intussusception is a rare clinical condition in adults. The predominant aetiology of intussusception in adults is a pathological lead point, with malignant lesions being the most common type. Lipomas are benign tumours of adipocytes that can sometimes be difficult to diagnose without histopathological confirmation as we highlight with this case report. We report a case of an asymptomatic female patient in her 50s who presented with an intussusception due to a giant colonic lipoma. Her CT imaging showed the possibility of a low-grade liposarcomatous component or atypical lipomatous tumour component. A laparoscopic right hemicolectomy was performed due to intussusception with the possibility of leading to colonic obstruction as well as diagnostic uncertainty of the risk of malignancy. Histopathology confirmed the diagnosis of a lipomatous lesion. In cases such as this, early surgical management is appropriate to rule out malignancy and prevent emergency presentation and surgery.
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Affiliation(s)
- Pan Su Pyae Kyaw
- School of Medicine and Health, University of New South Wales, Coffs Harbour Rural Clinical School, Coffs Harbour, New South Wales, Australia
| | | | - Andrew Sutherland
- Department of General Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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10
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Goyal MK, Gupta YK, Mehta V, Singh A, Sood A. Colonic Lipoma: A Rare Cause of Intussusception. Cureus 2023; 15:e48074. [PMID: 38046502 PMCID: PMC10689579 DOI: 10.7759/cureus.48074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
The most common and challenging chief complaint in the emergency department is abdominal pain. Intussusception, although rare in adults, is an important etiology to consider. The diagnosis is often delayed because of the nonspecific symptoms, especially in adults. This case highlights a rare case of intussusception in a middle-aged male with a colonic lipoma as a leading point. Endo-loop was applied to the colonic lipoma, leading to the resolution of intussusception. Therefore, this can be an effective alternative to surgery in select cases.
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Affiliation(s)
- Manjeet K Goyal
- Gastroenterology and Hepatology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Yogesh K Gupta
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Varun Mehta
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Arshdeep Singh
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ajit Sood
- Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, IND
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Niazi SAK, Raza MS, Mukhtar MU, Hassan R, Nasir MU. Colonic lipoma mimicking malignancy and presenting as an intussusception: A rare case report. Int J Surg Case Rep 2023; 109:108611. [PMID: 37566987 PMCID: PMC10425391 DOI: 10.1016/j.ijscr.2023.108611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Lipomas of the gastrointestinal tract are a rare entity compared to the more common tumors of the gut, such as adenomatous polyps and carcinomas. They were first described by Bauer in 1757. Gastrointestinal lipomas can grow in all segments of the gut, with the highest frequency in the colon. In this case report, we present a rare case of gastrointestinal lipoma mimicking colonic malignancy and causing intussusception, necessitating emergent surgery. This paper highlights the potential diagnostic challenges and therapeutic interventions associated with GI lipomas. CASE PRESENTATION A 28-year-old female presented with symptoms of abdominal pain, weight loss, vomiting, and changes in bowel habits. Initially, she received a misdiagnosis of Irritable Bowel Syndrome. Subsequent investigations indicated the possibility of colonic malignancy. During the intra-operative biopsy, it was ultimately discovered that she had a colonic lipoma. CLINICAL DISCUSSION CT revealed an abdominal mass and an intussusception, indicating the need for surgical intervention. A laparoscopic procedure was performed to remove the mass, which alleviated the symptoms. Subsequently, a histological examination confirmed the mass to be a lipoma. CONCLUSION Differentiating a gastrointestinal lipoma from malignancy is crucial, and careful investigation is necessary to determine if a local excision can be performed instead of a wide excision.
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Haider S, Peller M, Lamm V, Bazarbashi AN. Loop-and-let-go technique for the management of symptomatic large colonic lipoma. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:325-327. [PMID: 37575145 PMCID: PMC10422078 DOI: 10.1016/j.vgie.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1We depict (1) identification of a large lipoma in the sigmoid colon; (2) radial echo endoscopy confirming diagnosis; (3) removal with the loop-and-let-go technique; (4) ex vivo demonstration of the technique; and (5) an interval follow-up demonstrating healing of the lesion.
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Affiliation(s)
- Syedreza Haider
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Peller
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Vladimir Lamm
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
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Vieiro Medina MV, de la Fuente Bartolomé M, Alonso Murillo L, Jiménez de Los Galanes S. Colocolic intussusception by lipoma in transverse colon. A cause of intestinal obstruction. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 37204094 DOI: 10.17235/reed.2023.9690/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Lipomas in the colon usually present as sessile polypoid masses, rarely pedunculated, with variable dimensions. They are generally asymptomatic and diagnosed incidentally although occasionally they may debut with symptoms. We present the case of a 48-year-old male with intestinal obstruction secondary to colonic lipoma causing invagination at the level of the transverse colon.
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Hubbard G, Wood K, Vudayagiri L, Chong H, Gemma R. Colonic Intussusception Due to a Cecal Tumor: A Representative Case. Cureus 2023; 15:e36338. [PMID: 37077612 PMCID: PMC10108979 DOI: 10.7759/cureus.36338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
We present a case of ileo-colic intussusception in a 58-year-old female, with representative clinical features and useful intraoperative images. These cases are relatively rare in adults and should always be concerning for underlying malignancy, as was seen in our patient's case. In recent years, there has been a slight shift in the management of this pathology, and we present our arguments in agreement with these changes.
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Affiliation(s)
- Grant Hubbard
- General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
| | - Keaton Wood
- General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
| | | | - Hannah Chong
- General Surgery, Rocky Vista University College of Osteopathic Medicine, Greenwood Village, USA
| | - Rick Gemma
- General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
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Dong QJ, Yao Y, Zhang CL, Li XG, Chen X, Wang Y. Predictors of malignant intussusception in adults using clinical manifestations and multidetector computed tomographic findings. Eur J Radiol 2023; 160:110692. [PMID: 36640714 DOI: 10.1016/j.ejrad.2023.110692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the diagnostic performance of clinical manifestations and multidetector computed tomographic (MDCT) features in detecting predictors of malignant intussusception in adults. MATERIAL AND METHODS We retrospectively reviewed 88 adults with 91 intussusceptions who were diagnosed by MDCT. Their clinical manifestations and MDCT features were reviewed and compared between the malignant and benign groups. Uni- and multivariate logistic regression analyses were used to identify independent predictors of malignant intussusception. RESULTS There were 61 patients in the malignant group and 27 patients in the benign group. The malignant group had older age (mean, 62.61 vs 54.22 years, P = 0.014), more colon-related intussusception (89.06% vs 55.56%, P < 0.001), shorter intussusception length (median, 6.53 vs 9.73 cm, P = 0.009), higher maximum short axis diameter (mean, 4.85 vs 4.10 cm, P = 0.001), more enlarged lymph nodes (40.63% vs 11.11%, P = 0.006) than the benign group. Lead points were mainly presented as masses, which were irregular (44.74%) and lobular (28.95%) in the malignant group, and round or oval (92.00%) in the benign group. On the unenhanced MDCT, 90.62% of them in the malignant group showed non-hypodense. Multivariate analysis showed that intussusception length (P = 0.013), maximum short axis diameter (P = 0.007), non-round/oval lead point (P < 0.001) and non-hypodense lead point (P = 0.030) were independent factors of malignant intussusception. CONCLUSION Malignant intussusception can be identified using independent predictors such as intussusception length, maximum short axis diameter, non-round/oval and non-hypodense lead point. When integrating these four factors, radiologists can make qualitative diagnoses withhigher sensitivity and specificity, allowing clinicians to develop more appropriate treatments.
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Affiliation(s)
- Qiu-Jie Dong
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yun Yao
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Chun-Lai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiao-Guang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiao Chen
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China.
| | - Yi Wang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China.
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16
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Choi CCM, Arafat Y, Shamassi M, Cho J, Yeung JMC. Large bowel obstruction caused by a submucosal colonic lipoma: not all lipomas are trouble free. ANZ J Surg 2023. [PMID: 36772883 DOI: 10.1111/ans.18315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/14/2023] [Accepted: 01/21/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Colin C M Choi
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
| | - Yasser Arafat
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Maryam Shamassi
- Department of Anatomical Pathology, Western Health (Dorevitch Pathology), Melbourne, Victoria, Australia
| | - Jin Cho
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
| | - Justin M C Yeung
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
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Deshmukh S, Pol V, Bhosale A, Pol J, Dugad V. Intestinal lipoma causing intussusception in an adult – A case report. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2023. [DOI: 10.4103/mjdrdypu.mjdrdypu_929_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Palacios MF, Guachilema Ribadeneira A, Morocho Imbacuan S, Lisintuña Cisneros A, Basantes AD. Colonic lipoma of the hepatic flexure causing invagination in an adult. J Surg Case Rep 2022; 2022:rjac440. [PMID: 36196125 PMCID: PMC9522421 DOI: 10.1093/jscr/rjac440] [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] [Received: 08/16/2022] [Accepted: 09/03/2022] [Indexed: 11/13/2022] Open
Abstract
Intussusception is a rare condition in adults that can lead to intestinal obstruction due to malignant or benign lesions in the wall of the colon. Among the benign causes, lipomas are adipose tissue tumors that are most frequently located in the ascending colon. Invagination is characterized by nonspecific symptoms and normal laboratory test results. The exact point of invagination can be detected using advanced imaging studies such as abdominal computed tomography and colonoscopy. Invagination is treated surgically. Here, we presented the case of a female patient with colo-colonic invagination caused by a large lipoma diagnosed by computed tomography who underwent right hemicolectomy with primary ileocolonic anastomosis.
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Erginoz E, Uludag SS, Cavus GH, Zengin K, Ozcelik MF. Clinicopathological features and management of colonic lipomas: Case reports. Medicine (Baltimore) 2022; 101:e29004. [PMID: 35451395 PMCID: PMC8913087 DOI: 10.1097/md.0000000000029004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management. PATIENT CONCERNS In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia. DIAGNOSIS Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis. INTERVENTIONS Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma. OUTCOMES Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up. CONCLUSION Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful.
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Affiliation(s)
- Ergin Erginoz
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Server Sezgin Uludag
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Gokce Hande Cavus
- Department of Pathology, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kagan Zengin
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Faik Ozcelik
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
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