Intestinal Obstruction Caused by Ileocolic and Colocolic Intussusception in an Adult Patient with Cecal Lipoma

Abstract

Introduction. Intussusception is a rare clinical entity in adults (<1% of intestinal obstructions). Colonic intussusception is even rarer, particularly when caused by lipomas. Case Presentation. A 47-year-old woman presented to our emergency department complaining of abdominal pain with vomiting and diarrhoea. X-ray and CT showed bowel obstruction due to ileocolonic and colocolonic intussusception; a giant colonic lipoma (9 × 4 × 4 cm) was recognizable immediately distally to the splenic flexure of the colon. The patient underwent emergency laparotomy and right hemicolectomy. Assessment of the resected specimen confirmed the diagnosis of giant colonic polypoid lesion near to the ileocecal valve, causing a 12 cm long intussusception with moderate ischemic damage. Conclusion. Colonic obstruction due to intussusception caused by lipomas is a very rare condition that needs urgent treatment. CT is the radiologic modality of choice for diagnosis (sensitivity 80%, specificity near 100%); since the majority of colonic intussusceptions are caused by primary adenocarcinoma, if the etiology is uncertain, the lesion must be interpreted as malignant and extensive resection is recommended. At present, surgery is the treatment of choice and determines an excellent outcome.

Colorectal intussusception with rectal prolapse related to cecal lipoma in adult: A rare case report and review of the literature

“…Intussusception was first reported in 1674 by Barbette and further reported in detail in 1789 by John Hunter [ 1 , 3 ]. This condition is the telescoping of a proximal segment of the bowel known as intussusceptum into the distal segment of the GI tract, called intussuscipiens.…”

“…Colonic lipomas are rare benign tumors (seen 0.2%–4.4% in large autopsy series), and cecal lipoma incidence is only %19 among them. They are generally asymptomatic but may cause crampy abdominal pain, constipation, nausea, vomiting, and other mechanical bowel obstruction symptoms, especially when larger than 4 cm [ 3 ].…”

Jejunal intussusception in an adult due to multiple lipomas: a rare case report from Syria

“…Neoplasms are the most common cause of intussusception in adults (60% of causes). These neoplasms are 60% malignant and 40% benign [7].…”

Appendiceal necrosis resulting from cecal lipoma-induced ileocolic intussusception

“…CT is the radiologic modality of choice for diagnosis (sensitivity 80% and specificity near 100%); since the majority of colonic intussusceptions are caused by primary adenocarcinoma, if the etiology is uncertain, the lesion must be interpreted as malignant and extensive resection is recommended. [12] Surgery is the definitive treatment of adult intussusceptions. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected.…”