Lipoma induced jejunojejunal intussusception

Abstract

Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is, therefore, elusive. The presence of a structural abnormality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity. The present report describes a case of jejunojejunal intussusception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography scan could not rule out malignancy. Exploratory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental intestinal resection.

Figure 1

Abdominal computed tomography showed an obstructive lesion of the jejunum with dilatation of the edematous adjacent bowel loops. Enteroclysis showed a circular obstructive lesion of the jejunum with apple-core appearance. Close observation of the lesion shows the presence of radiation-lucent linear markings, with barium fillings on either side, projecting to the adjacent loop consistent with the walls of the intussusceptum.

Figure 2

A pedunculated lesion, measuring 4 cm × 4 cm, was the lead point of the intussusception. The lesion was covered with mucosa and was composed of smooth submucosal fat. The clinical diagnosis of jejunal lipoma was subsequently confirmed at pathologic evaluation.