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

Ouadii Mouaqit,Leila Chbani,Khalid Maazaz,Abdelmalek Oussaden,Khalid Ait Taleb,Afaf Amarti,Hafid Hasnai

doi:10.1186/1471-2482-13-51

Ouadii Mouaqit, Leila Chbani + Show 5 more

Open Access

https://doi.org/10.1186/1471-2482-13-51

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Journal: BMC surgery	Publication Date: Oct 30, 2013
Citations: 44	License type: cc-by

Affiliation: Centre Hospitalier Universitaire Hassan II

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.

Highlights

ConclusionA large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy
Intussusception 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
Computed tomography (CT) and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, those rising into the layers of the colonic wall

Summary

Conclusion

Intussusception remains a rare condition in adults, representing 1% of bowel obstructions or 0.003% to 0.02% of all hospital admissions. 90% of adult intussusceptions have an organic cause, 60% developing due to neoplasms Since only about 9% to 10% of adult intussusceptions present with the typical triad of abdominal pain, palpable abdominal mass and bloody stool. Imaging modalities can contribute to the preoperative diagnosis of colonic lipomas. Recent reports [10] in the literature have suggested that abdominal CT scanning is the preferred radiologic modality for diagnosing intussusception from colonic lipomas. In view of the uncertain etiology and diagnosis and high incidence of malignancy (approaching 50%), the treatment of intussusception in adults is invariably surgical resection [2,4,5,6]. The present case highlights the possibility of intussusception with an unusually benign cause, such as lipoma, when adult patients present with nonspecific abdominal symptoms and small bowel obstruction.

Background

Findings