A rare presentation of adult colonic intussusception secondary to a descending colon lipoma: A case report

BACKGROUNDColo-colonic intussusception is an uncommon phenomenon in an adult. Adult intussusception accounts for < 5% of total cases, and the colo-colonic type is < 30% of cases. Although surgical management has been the treatment of choice for intestinal intussusception in adults, because most frequent causes for adult intussusception are malignant in origin, the importance of the roles of preoperative colonoscopic evaluation has recently been emerging.CASE SUMMARYWe report an extremely rare case of adult colo-colonic intussusception caused by colonic anisakiasis and successfully treated by endoscopic removal of the Anisakis body. A 59-year-old man visited the emergency department due to 1 day of lower abdominal colicky pain. Abdominopelvic computed tomography (APCT) revealed the presence of mid-transverse colon intussusception without definite necrosis, which was possibly related with colorectal cancer. Because there was no evidence of necrosis at the intussusception site, a colonoscopy was performed to target the colonic lesion and obtain tissue for a histopathological diagnosis. An Anisakis body was found when inspecting the suspicious colonic lesion recorded by APCT. The Anisakis body was removed with forceps assisted by colonoscopy. The patient’s symptoms improved dramatically after removing the Anisakis. A reduced colon without any pathological findings was seen on the follow-up APCT. Without any further treatment, the patient was discharged 5 d after the endoscopy.CONCLUSIONWhen colonic intussusception without necrosis occurs in an adult, physician should consider a colonoscopy to exclude causes cured by endoscopy.

Intussusception is a rare condition in adults, accounting for approximately 5% of all cases. Unlike pediatric intussusception, which is typically idiopathic, the adult cases are usually associated with an underlying pathology, most commonly malignancies. The surgical intervention is often required, but in small bowel cases, where malignancy is less frequent than in colonic intussusception, the decision regarding resection requires careful consideration. There are no prior reports on the use of intraoperative enteroscopy for small bowel intussusception evaluation. We report the case of a 78-year-old woman who presented with acute abdominal pain, nausea, and bilious vomiting. She had a history of distal gastrectomy with gastroduodenostomy (Billroth-I) and total gastrectomy with Roux-en-Y for gastric ulcer and residual stomach cancer, respectively. Abdominal computed tomography (CT) revealed small bowel intussusception without clear evidence of a lead point lesion. The emergency laparotomy confirmed intussusception 15cm distal to the Roux-en-Y anastomosis, which was manually reduced. The intraoperative enteroscopy revealed inflammatory changes but no malignancy or structural abnormalities. Given the absence of a lead point lesion and the viability of the bowel, resection was avoided. The patient had an uneventful postoperative course and was discharged without complications. Adult intussusception is frequently associated with malignancy, yet cases without a lead point lesion pose a diagnostic and therapeutic challenge. The surgical history, including prior anastomotic procedures, may contribute to the pathogenesis through disrupted intestinal pacemaker activity and retrograde contractions. While second-look surgery can aid in bowel viability assessment, it carries a high complication rate. This case highlights the potential role of intraoperative enteroscopy in evaluating small bowel viability, minimizing unnecessary resection, and improving surgical decision-making. Although further studies are needed to assess its role in optimizing surgical outcomes, intraoperative enteroscopy may be a valuable adjunct in cases of adult small bowel intussusception without an apparent lead point.

Introduction: Intussusception is defined as the telescoping of one intestinal segment into the adjacent segment. It is rare in adults and most often secondary to an underlying cause, but the exact mechanism remains undefined. It is classified based on location and etiology. Malignant pathology is the most common, particularly for colonic intussusception. Lipoma is a rare cause of intussusception. Case Report: In this article, we report the rare case of a patient who presented with sigmoid intussusception due to a lipoma, treated by surgical resection. Discussion: Intestinal intussusception in adults is different from that in children, which is most often idiopathic. Malignant tumor pathology represents two-thirds of colonic intussusceptions. Colonic lipoma is a rare cause of intussusception; the diagnosis is established through CT scans and colonoscopy, but it is often difficult to differentiate it from cancer. This is why the case we present is interesting due to its location in the sigmoid colon, which is not common, and the diagnostic uncertainty poses a challenge for therapeutic management. Conclusion: The management of colonic intussusception in adults is not universally accepted; in cases of diagnostic uncertainty regarding the histological nature of the causal pathology, en bloc surgical resection without prior disinvagination seems to be the most appropriate approach given the high risk of malignancy.

Sigmoid lipoma as an exceptional cause of intussusception and bowel obstruction in adults: A case report and review of literature

Purpose. Adult intussusception is a uncommon disease, and the colonic inrussusception is less than enteric intussusception. Because of the limited experience with such clinical entities, we report a series of adult colonic intussusception to discuss diagnosis and treatment. Methods. From January 1997 to December 2008, a total of 18 patients with adult colonic intussusceptions were reviewed. We divided the patients into colocolic group and ileocolic group and analyzed the data of these 18 patients. Results. There were 11 ileocolic intussusception and 7 colocolic intussusception. The mean duration of symptoms was 22.2 days (range 1 to 105 days), and abdominal pain was represented in all patients. Only one patient underwent hydrostatic reduction without operation and others underwent bowel resection with organic lesion. One hundred percent of colocolic intussusception cases were malignant lesions and this was more than ileocolic intussusceptions (27% and p＜0.001). All patients with colon cancer had a favorable outcome and are still alive. Conclusion. Colonic intussusception in adults is a rare disease. Abdominal pain is complained of by all patients but the symptoms have various duration. Abdominal ultrasonography and computed tomography are useful tools for colonic intussusception diagnosis. In our study, colocolic intussusception had more malignant probability than ileocolic intussusception. Primary resection with associated lymph node dissection without reduction is the principle method of treatment.

Background: Intestinal intussusception is a common condition in children, and the cause is often idiopathic. In contrast, adult intussusception is rather rare and almost always secondary due to an underlying condition such as a tumor, inflammatory disease, or a diverticulum. Hence, the treatment almost always is surgical resection of the lesion.Methods: We retrospectively analyzed a case of asymptomatic intussusception in a male adult using patient data retrieved from the hospital patient database. This includes findings from both physical and radiological and endoscopical examinations. The patient was contacted 4 weeks and 6 months postsurgery for a clinical follow-up.Aim: Until this day, there is no guideline regarding the underlying pathology. Hence, this case report wants to contribute to a field where there is only insufficient patient data.Results and Discussion: We presented a case of colocolic intussusception in an adult caused by a large intramural lipoma. After a full gastrointestinal diagnostic protocol and interdisciplinary case discussion, we decided to offer surgical resection, from which the patient recovered quickly. The benign nature of the tumor and the complete lack of symptoms despite significant tumor size make this case particularly interesting. We emphasize the need for a larger study group to create robust data that aid in creating care guidelines.

Adult sigmoidorectal intussusception related to colonic lipoma: A rare case report with an atypical presentation

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. 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.

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.

IntroductionIntestinal intussusception is a relatively common cause of bowel obstruction in children, however, it is a rare clinical entity in adults. When seen in adults, it is often caused by some underlying condition, usually of malignant origin. We present a case of intestinal intussusception caused by a benign and rare condition in the gastrointestinal tract. Case presentationA 69-year-old male patient presented with diffuse abdominal pain for 2 months, which intensified in the last two days, associated with diarrhea, vomiting and weight loss, in addition to sporadic episodes of hematochezia. Colonoscopy revealed a vegetative-infiltrative lesion, occupying about 75% of the lumen of the colon, located in the hepatic angle, presumably neoplastic. A biopsy was performed, which revealed mild nonspecific chronic inflammation in activity, in fragments of colonic mucosa. CT scan demonstrated colo-colonic intussusception, associated to an oval formation presenting fat density, suggesting lipoma. The patient underwent laparotomy with intussusception reduction and right partial colectomy. The inspection of the specimen showed a yellowish, pedunculated lesion. Histopathology confirmed a 5.0 cm submucosal lipoma. DiscussionIntestinal intussusception is relatively frequent in children and is a rare clinical condition in adults at a ratio of 20:1.4. Sixty to sixty-five percent of the cases of intussusception in the large intestine have malignant etiology. Thus, lipoma as the main cause of colo-colonic intussusception in adults is an uncommon cause. ConclusionAlthough rare, colonic lipoma should be considered as a differential diagnosis among the causes of large intestinal intussusception in adults.

Adult intussusception is uncommon and usually presents with nonspecific symptoms. Cross-sectional imaging is extremely important for diagnosis. In adults, a lead point is often present and indicates the underlying cause, which can be benign or malignant. Therefore, the primary treatment is surgical resection. Colonic lipoma, although rare, is a frequent benign lesion that leads to colocolic intussusception.This report describes a 42-year-old woman who presented with 12 days of intermittent abdominal pain and no other associated symptoms. After multiple emergency department (ED) visits, her symptoms were initially attributed to constipation, as physical examination revealed only mild right lower quadrant tenderness, routine blood tests were within normal range, and abdominal X-ray (AXR) showed stool loading in the right colon. Subsequent cross-sectional imaging revealed a colocolic intussusception caused by a 5 cm submucosal lipoma acting as the lead point. She underwent open segmental colectomy with a primary side-to-side stapled anastomosis and was discharged on postoperative day eight without complications. Histopathology confirmed the presence of a lipoma and an incidental serrated adenoma.This case highlights the diagnostic challenge and the importance of cross-sectional imaging in patients presenting with nonspecific abdominal pain. Intussusception should be considered in the differential diagnosis of adults with abdominal pain. Computed tomography (CT) is essential for timely diagnosis, and surgical resection remains the mainstay of treatment, particularly in colocolic involvement.

Objective: To study the clinical characteristics, investigations, management and pathology in adult colonic intussusception.Methods: A retrospective study of seven adult patients who were operated on for the diagnosis of colonic intussusception in our department from January 1999 to September 2003 was carried out. The case records of the seven patients were retrieved. Their clinical presentations, investigations, operative records and pathology were studied.Results: The mean age of the patients was 67.4 years. There were four men and three women. Five of the patients presented with chronic non‐specific symptoms and the other two patients presented with acute symptoms. Transabdominal ultrasonography (USG) and computed tomography (CT) scan were used for investigation. In the majority of the patients (87.5%), radiological features of intussusception were shown by USG or CT scan. All seven patients underwent laparotomy exploration with bowel resection. Six patients (85.7%) had lead points with definable pathology. Within the lead points, five patients had primary malignant lesions.Conclusion: With more liberal use of imaging techniques, more adult intussusception can be diagnosed before explorative surgery. Ultrasound would be an ideal tool for initial evaluation. In view of the high chance of associated malignancy, adult colonic intussusception should be resected without prior reduction at the time of surgery.

Adult colo-colonic intussusception caused by congenital bands: A case report and literature review

Adult intussusception is a rare entity that is almost always associated with a demonstrable lead point. There has been a notable association between adult intussusception and inflammatory fibroid polyp (IFP) or Vanek’s tumour. These polyps are benign tumours arising from submucosa, comprising of mesenchymal cells like fibroblasts and numerous variably prominent small blood vessels along with chronic inflammatory cells commonly eosinophils. Inflammatory fibroid polyps are uncommon; moreover, these polyps causing secondary intussusception in an adult is still rarer. Clinical manifestations of IFP vary based on size and location within the GI tract. Here, we report a case of inflammatory fibroid polyp of ileum, presented as acute on chronic pain abdomen in a 38-year-old woman. The rareness of the disease made it a clinical challenge to subject the patient to laparotomy. However this patient underwent resection of the intussuscepted small bowel with primary anastomosis. The rareness of non-malignant condition being the cause for adult ileo-ileal intussusception and the clinical challenge associated with it makes it a case worth reporting.

Intussusception is a rare phenomenon in adults and usually presents with bowel obstruction. Unlike pediatric intussusception, adult intussusception (AI) is seldom idiopathic and frequently associated with secondary causes such as benign and malignant tumors. AI accounts for 5% of all cases of intussusception and almost 1%–5% of all cases of bowel obstruction. We hereby present the rare case of a 42-year-old female patient with ileoileal intussusception caused by an inflammatory myofibroblastic polyp. We also delve into a review of literature on AIs, touching different common and uncommon types as well as their diagnostic modalities and therapeutic options.