Colo-colonic intussusception due to large submucous lipoma: A case report

Abstract

Introduction: Intussusception in adult is rarely caused by idiopathic conditions. Main causes are inflammatory diseases, benign or malignant tumors and motility disorders. As a benign cause, lipomas appear as a particularly rare gastrointestinal intraluminal tumor occurring with highest incidence in the colon, mostly in the caecum and ascending colon.

Presentation of case: A 57-year-old male patient was admitted at the surgical emergency in Belo Horizonte, with history of chronic and intermittent diffuse abdominal pain, associated with variations of his bowel habits and rare episodes of vomiting starting around 3days prior to admission.

Discussion: Intussusception is the cause of adult symptomatic bowel obstruction in 1% of the cases and its colocolonic occurrence represents 17% of all intestinal intussusceptions in adults. The reported case presents itself as even rarer considering its evaluation according to the epidemiological statistics of 1:5 men/women ratio and lipoma's most common location being the right colon. Intussusception and intestinal obstructions caused by intraluminal lipomas are not often described in the literature and its occurrence is directly related to its size, usually larger than 2cm diameter. The management of lipomatous intraluminal lesions of the colon is traditionally surgical, and it allows a selective resection, depending on the size of the tumor, length of intussusception, and the amount of inflammation.

Conclusion: Patients with chronic abdominal symptoms and semi-obstruction caused by intussusception are rarely diagnosed before surgery unless there is a high index of suspicion. Colonoscopy contributes to diagnosis given that it provides direct visualization and biopsy.

Keywords: Chronic abdominal pain; Colo-colonic intussusception; Submucous lipoma.

Fig. 1

Ultrasonographic assesment showing heterogeneous mass in the left flank, with an diameter of 60,5 mm.

Fig. 2

Tomographic imaging showing colo-colonic intussusception causing partial obstruction due to intraluminal mass of suggested 6 cm with lipomatous aspect.

Fig. 3

Colonoscopy showing submucosal mass of fibro-elastic consistency, with intact mucosa but with small area of necrotic tissue.