Pedunculated lipoma causing colo-colonic intussusception: a rare case report

Abstract

BackgroundIntussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy.Case presentationA 55-year old man visited our emergency department with severe abdominal pain, multiple episodes of vomiting, abdominal distension. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign, suggestive of intussusception. Surgery revealed a hard elongated mass in the right colon wihch telescoped in the transverse colon and caused colo-colonic intussusception. Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.ConclusionA large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy. CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall. Surgical resection remains the treatment of choice and produces an excellent prognosis.

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

“…90% of cases have an organic cause, 60% due to neoplasm (60% malign and 40% benign) [2]; in particular 65–70% of adult colonic intussusceptions are caused by carcinomas [3]. Colonic lipoma is the most common benign tumor which causes colonic intussusception in adults, but very rarely [5].…”

“…It is relatively frequent in children but rare in adults, representing 5% of all bowel intussusceptions and 1% of all bowel obstruction [2, 3]. …”

A Giant Sumucosal Lipoma of Large Intestine Presenting With Intussusception in An Adult: A Case Report.

“…Lipoma appears with fatequivalent density, near ovoidal shape, and smooth margins.However, intussuscepted lipomas may have a heterogeneous appearance reflecting the degree of infarction and fat necrosis [5,16] . There are different options for treatment.…”

“…In case of intussusception, abdominal CT scanning is the radiologic modality of choice, above all when giant lipomas are present, with a 70-80% sensitivity and near 100% specificity [5,15] . Lipoma appears with fatequivalent density, near ovoidal shape, and smooth margins.However, intussuscepted lipomas may have a heterogeneous appearance reflecting the degree of infarction and fat necrosis [5,16] .…”

Lipomas – a health condition that cannot be ignored

“…lipomas are the third most common tumors of the colon after hyperplastic and adenomatous polyps [12,14]. in 94% of cases, there are no symptoms [15]. lipomas measuring in diameter more than 4 cm are considered large and may cause symptoms such as: pain, diarrhea, constipation, vomiting, nausea, obstruction, intussusception and bleeding [8,16,17].…”