Jejunal Lipoma-Induced Intussusception Mimicking Crohn's Disease: A Case Report

Abstract

Introduction: Chronic gastrointestinal bleeding in patients with Crohn's disease presents diagnostic challenges. Adult intussusception is rare and typically caused by a pathological lead point, such as a tumor or inflammatory lesion. Lipomas, though benign, can lead to obstruction and bleeding, requiring differentiation from inflammatory causes for appropriate management.

Case presentation: A 70-year-old male with Crohn's disease and chronic anemia presented with recurrent obscure gastrointestinal bleeding. Initial endoscopy was unremarkable, but capsule endoscopy identified a bleeding jejunal lesion. Double-balloon enteroscopy and imaging confirmed a jejunal lipoma causing intermittent intussusception. Due to persistent anemia, the patient underwent laparoscopic resection, with pathology confirming an ulcerated lipoma. His anemia resolved postoperatively.

Conclusion: This case underscores the importance of considering structural lesions like lipomas in patients with chronic bleeding and Crohn's disease. A multimodal approach, including advanced imaging and enteroscopy, is crucial for accurate diagnosis and management. Surgical resection remains the preferred treatment for symptomatic small bowel lipomas.

Keywords: Crohn’s disease; Differential diagnosis; Intussusception; Small intestine.

Fig. 1.

5-cm frond-like villous lesion and no evidence of active inflammation related to his history of Crohn’s disease.

Fig. 2.

MRI demonstrating enteroenteric intussusception measuring approximately 7.7 cm in length with a 4.7 cm jejunal lesion just distal to the site of intussusception. The lesion appears to lose signal, indicating the presence of fat.

Fig. 3.

a Laparoscopic removal of the small bowel mass 5-cm villous lesion. b No evidence of active inflammatory bowel disease. c Cross-section of the jejunal mass showing a lipomatous center.