Large colonic lipoma as a lead point for intussusception in an adult

Abstract

Intussusception is the telescoping of proximal loop of the bowel within distal loop resulting in obliteration of the lumen. Although it frequently occurs with the most common cause of intestinal obstruction in children, it is a rare phenomenon and an uncommon cause of acute intestinal obstruction in adults. Unlike pediatric intussusception, where the cause is idiopathic, adult intussusception is associated with underlying pathology as a lead point. The underlying pathology usually is malignant, but the prognosis is better when there is a benign lead point. The benign lead point intussusceptions are rare and are treated with reduction when there are no signs of ischemia. When there is ischemia or when reduction is not feasible, they are treated with surgical resection. In this report, we describe a rare case of an adult intussusception from a large colonic lipoma in a 79-year-old male, treated successfully with surgical resection.

Figure 1

CT scan scout showing distended colon proximal to a soft tissue mass/ shadow at the splenic flexure.

Figure 2

CT scan pelvis (axial cut) showing a soft tissue lesion in the left colon, with surrounding fat stranding and distended right colon.

Figure 3

CT scan pelvis (axial and coronal cuts) showing a soft tissue lesion in the left colon, with surrounding fat stranding and distended right and transverse colon.

Figure 4

The left hemicolectomy specimen opened to show the intraluminal lipomatous lesion causing the mechanical obstruction at the splenic flexure.