A Rare Case of Adult Colonic Intussusception from Benign Etiology

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.

Recurrent colonic intussusception due to a lipoma of the transverse colon at the background of congenital dolichocolon and chronic constipation

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.

Colonic intussusception caused by a sigmoidal lipoma: A case report

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Intestinal intussusception in adults is rare, accounting for approximately 1% of all bowel obstructions.

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Colo-colonic intussusception accounts for 17% of cases.

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The occurrence of large lipomatous masses as cause of intussusception and semi-obstructive symptoms remains rare.

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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.

Peutz-Jeghers Syndrome Presenting as Colonic Intussusception: A Rare Entity

Peutz-Jeghers syndrome is an autosomal dominant inherited medical condition characterized by hyperpigmented mucocutaneous macules, hamartomatous polyps in the digestive tract, and with a greater risk of gastrointestinal and non-gastrointestinal cancers. In fact, without appropriate medical surveillance, the lifetime risk for all cancers combined may be as high as 93%. The syndrome is rare, with estimates of incidence varying between 1 in 8,300 and 1 in 280,000 live births. Infrequently, individuals present for the first time with bowel obstruction secondary to intussusception. Here, we present an interesting case of a young Burmese man who, early on, showed traits of Peutz-Jeghers syndrome, including the characteristic hyperpigmented areas on the fingers and lips. Unfortunately, the diagnosis was not made until he later developed bowel obstruction caused by an intussusception, requiring exploratory laparoscopic bowel resection. A high index of suspicion is needed to diagnose accurately. However, early identification and close surveillance can lead to excellent prognosis in these individuals.