Gastrointestinal: A sigmoid lipoma as the cause of intussusception

Abstract

Gastrointestinal: A sigmoid lipoma as the cause of intussusceptionA 64 year-old female with a past medical history of hypertension and hypothyroidism presented to general medicine clinic with 1 month of intermittent left lower quadrant abdominal pain and 1 day of hematochezia. About 3 months prior to presentation, she underwent screening colonoscopy at an outside hospital, which identified a 5 cm submucosal lipoma. The day of presentation, she reported five episodes of hematochezia with bright red blood and clots. She was sent to the emergency room for further evaluation where a CT scan of her abdomen and pelvis identified an intussusception immediately proximal to the lipoma (Fig.1).Lipomas are the second most common benign colon neoplasms after adenomatous polyps and account for about 4% of all benign tumors in the gut. Over 70% are found in the right colon. Specifically, the most common location is the cecum, followed by the ascending and then the sigmoid colon. Most colonic lipomas are asymptomatic and are found during colonoscopy or surgery for other indications. However, symptoms correlate with size of the lipoma, and lipomas larger than 4 cm in size (giant lipomas) become symptomatic in 75% of patients. The most common symptoms include abdominal pain and alteration in bowel habits. More rarely, they may presents with obstruction, perforation, or gastrointestinal bleeding. Giant lipomas are the most common benign colonic tumors leading to intussusception. When complicated by intussusception or perforation, surgical management is necessary. For patients incidentally found to have a lipoma, small lipomas (<2 cm) can generally be observed. Options for managing larger asymptomatic lipomas include both surgical and endoscopic resection (Fig. 2). Figure 1 A classic target sign (arrow) of alternating hypodense and hyperdense layers is seen at the level of the intussusception on CT scan.Figure 2 Gross pathology specimen of the resected colon including the lipoma (arrow).

Ileocecal Intussusception in an Adult Secondary to a Colon Adenocarcinoma: A Case Report and Literature Review

“…However, in our review, some cases indeed reported preoperative diagnosis of intussusception by imaging tests like our patient. While in colon adenocarcinoma is the most common tumor in an intussusception, the most frequent benign tumor that acts as a guiding point for intussusception both in small bowel and colon is submucosal lipoma, which prevails in the cecum followed by the ascending colon and the sigmoid colon; other causes include polyps, leiomyomas, Meckel's diverticulum, adhesions, Crohn's disease, inflammatory pseudotumor, intestinal lymphoma, appendix tumors and in few cases, it could be idiopathic in adults [1,3,4,7,[14][15][16]. Lastly, a greater number of pediatric and adult patients with cystic fibrosis had been reported with intussusceptions, being in these patient ten times more frequent than the rest of the population [17].…”

An unusual case of colonic intussusception in old age

“…The leading end of the intussusception, in this case, was a pedunculated colonic lipoma of about 7 × 5 cm in size. Gluskin et al 8 . reported that giant (>4 cm) lipomas are the most common benign colonic neoplasms leading to colonic intussusception.…”