Users Online: 238
Home Print this page Email this page
Home About us Editorial board Search Browse articles Submit article Ahead of Print Instructions Subscribe Contacts Special issues Login 


 
Previous article Browse articles Next article 
CASE REPORT
Adv Biomed Res 2022,  11:83

Colocolic intussusception because of lipoma in a 44-year-old adult


Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission18-Feb-2021
Date of Acceptance16-Apr-2022
Date of Web Publication27-Oct-2022

Correspondence Address:
Dr. Negin Salemi
Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/abr.abr_32_21

Rights and Permissions
  Abstract 


Lipoma is an uncommon mesenchymal tumor of the colon. They are typically symptom free, the large lipomas within the colon are rare, and can cause obstruction, bleeding, or intussusception. Intussusception is comparatively common in pediatrics and in adults, it could be a rare entity. Pathologic lesions are usually found with a major percentage of malignancy. This is a retrospective evaluation of an adult with an intestinal intussusception who underwent oncosurgical treatment. He was diagnosed with surgically proven intussusception. Using ultrasound and colonoscopy as diagnostic studies, colocolic intussusception was discovered. The patient underwent oncosurgical exploration. Intestinal resection with abrupt anastomosis was the procedure of choice for the patient. The etiology was benign lipoma. Adult intussusception should be evaluated in any patient with subacute abdominal discomfort with bearing in mind the high rate of malignancy and a lower rate of benign tumors. intestinal resection without reducing is highly recommended for colonic intussusceptions.

Keywords: Colon, colorectal neoplasms, intussusception, lipoma


How to cite this article:
Eshraghi Samani R, Salemi N, Firouzfar A. Colocolic intussusception because of lipoma in a 44-year-old adult. Adv Biomed Res 2022;11:83

How to cite this URL:
Eshraghi Samani R, Salemi N, Firouzfar A. Colocolic intussusception because of lipoma in a 44-year-old adult. Adv Biomed Res [serial online] 2022 [cited 2022 Nov 29];11:83. Available from: https://www.advbiores.net/text.asp?2022/11/1/83/359782




  Introduction Top


Lipomas within the colon are rare and most of them are in the sigmoid and ascending colon and are asymmetric. But if the lesion is more than 2-cm diameter, then it will be symptomatic and present with abdominal pain, bleeding, and obstruction,[1] and in extremely rare cases, lesions may cause massive hemorrhage, complete luminal obstruction, intussusceptions, and perforation that cause acute abdomen.[2] Also giant lipoma is the term used for lesions more than 5-cm diameter.[3] Nearly 90% of colonic lipomas arise from submucosa and, therefore, the leftovers are from subserosa. Lipomas have benign clinical courses and a low-recurrence rate after excision[4] and Bauer was the first to describe this entity in 1957.[5] After hyperplastic and adenomatous polyps, lipomas are the third most prevalent benign tumors in large bowl.[6] Intussusception of the bowel represents 1% of the causes of obstruction in adults and is explained as telescoping the proximal circlet of the bowel surrounded by the distal loop leading to the destruction of the lumen.[7] It is the most common reason behind bowel obstruction in infants, especially in the ages between 4 and 10 months and among males.[8] Adult intussusception is related to primary pathology in 90% of the patients with an equal prevalence in male and female patients occurs within the small bowel in 52% of the cases and large bowel in 38% with 10% encompassing the gastric part and causes surgical apertures.[9] It can rarely occur within the colon as there's no obvious peristalsis there, most of colon mass are caused by colorectal adenocarcinoma. There are also rarer causes reported in literatures like lipoma and angiolipoma.[10]

Clinical symptoms among adults are variable and broad-based as Patients may complain of generalized abdominal pain, nausea, vomiting, bloody stools, change in bowel habits, and abdominal distention and symptoms can be acute, subacute, or chronic. Physical examination can reveal abdominal distention or tender abdomen, although it usually does not reveal any abnormality. This condition can mimic other more common dysfunctions, such as inflammatory bowel diseases, bowel obstruction because of peritoneal adhesions, and infectious gastroenteritis; therefore, it makes the clinical diagnosis of adult intussusception more difficult. Diagnosing requires a high index of certainty that usually demands the use of imaging studies such as computed tomography (CT) scan.[7]

Intussusception without treatment can be life threatening, starting with developing bowel distension, which increases the intraluminal pressure, indicating microvascular ischemia, tissue necrosis with subsequent intestinal perforation, and peritonitis.[9] Hence, diagnosis and treatment at early stage of intussusceptions are critical to stay away from complications.

In this report, we present a case of an adult intussusception because of underlying malignant colonic neoplasm that was effectively diagnosed as lipoma and treated. We also discuss some diagnostic procedures and therapeutic interventions employed in the management of adult intussusception.

In this report, we describe an adult patient with intussusception because of underlying benign lipoma that was excellently diagnosed and treated. This report described a rare case and reviewed the relevant literature to standardize the necessary procedures required for the diagnosis and treatment of this kind of lesion.


  Case Report Top


A 44-year-old female patient, with no significant personal or family history, was admitted for a clinical picture of roughly 1 year of abdominal colic-type pain located within the right lower quadrant that radiates towards left flank and vomiting, dyschezia, and constipation. In addition, he had non-quantified weight loss. In an outpatient evaluation for the identical symptomatology, a complete abdominal ultrasound was performed during which thickening of transverse colon close to left side was identified. In the physical examination, the abdomen is not distended, peristalsis is positive, bowel sounds are normally soft, depressible, mildly painful tenderness on general palpation without signs of peritoneal irritation, no palpable masses, or organomegaly were identified; management with intravenous fluids was initiated, blood biochemistry and colonoscopy were requested as paraclinical studies. Laboratory blood tests showed leukocytosis with 15 × 109/L WBCs (normal range is between 4 and 11 × 109/L), hemoglobin 11g/dL (normal range is between 11.9 and 15.1 g/dL), and platelet count 550 × 109/L (normal range is between 150 and 450 × 109/L). Renal and liver function tests were within normal values also testing for HIV antibody reported negative. Colonoscopy revealed a colocolic invagination, located within the colon [Figure 1]. In the histopathological study of the samples extracted in the colonoscopy and during the surgery, a submucosal polypoid lipoma with reactive lymph nodes was identified. It was concluded that it was a colonic lipoma. CT scan was not requested because the patient underwent colonoscopy. Then, emergency surgery was performed. Following perp and drape under general anesthesia, the patient underwent a laparotomy, the abdomen was incised in lower midline fashion, and when we entered the greater peritoneal sac, there was mild intraperitoneal free fluid that was transparent. Then, colon was explored from the rectum to the proximal and that we found multiple simple cysts adjacent to the left ovary therefore cystectomy was done. Then, an invagination because of a lipoma was found in the transverse colon somehow nearer to splenic flexure than hepatic flexure. Then, the left toldt line was made free from the abdominal wall also splenic flexure was made free and taken down. Gastro colic ligament was made free from transverse colon, mid colic vessels were skeletonized, and partial colectomy was done [Figure 2], then Colo colic anastomosis was done. The abdominal incision was sutured [Figure 3]. Patient had four postoperative days of hospital stay without any complication and then discharged.
Figure 1: Colonoscopy

Click here to view
Figure 2: The resected part of the colon

Click here to view
Figure 3: Invagination was found at the transverse colon nearer to splenic flexure than hepatic flexure

Click here to view



  Discussion Top


Lipoma within the ductis is rare, esophageal lipomas account for 0.4% of all benign duct neoplasms. Gastric lipomas are commonly in submucosa within the antrum and remarkably rare, represent <5% of lipomas of the gastrointestinal tract,[7],[8] and it is more common in women between 40 and 70 years old.[9] Colon lipomas are rare, benign, and are typically asymptomatic and diagnosed accidentally in surgery, colonoscopy, or autopsy.[9] In some cases, they are often symptomatic and manifest with lower abdominal pain, bowel habits change, intussusceptions, hemorrhage, or perforation.[10] Colon lipoma is generally located within the right colon: 19% within the cecum, 38% in the ascending colon, 22% within the transvers colon, 13% within the descending colon, and 8% into the sigmoid region.[11] Intussusception is the telescoping of a proximal portion of the epithelial duct surrounded by the lumen of the nearby segment.[12] This state is rare in adults and the diagnosis is typically made during laparotomy.[13] Intussusception may arise at sites of benign or malignant lesions or are often with unknown etiology.[14] Among the adult population, 90% of lesions are related to a pathology, with a benign or malignant tumor origin.[15] Benign neoplasms are more frequent in small bowel intussusception, on the other hand, the incidence of malignant lesions is greater in colonic intussusception. Previous reports revealed around two thirds of adult Colo colic intussusceptions have a malignant etiology, other etiologies include polyps, anastomosis, adenomas, endometriosis, and interestingly lipomas, resection of the intestine including the lipoma, and therefore the invaginated segment of the colon can be the treatment in these cases.[16],[17] Preoperative diagnosis is important for planning in our case; the lesion was 55 × 3 × 3 mm in size and caused colocolic intussusception. Colonoscopy may be a useful gizmo to diagnose if there is colonic lipoma or cancer or other tumors by direct visualization of the lipoma.[11],[18] Invagination needs immediate intervention.[11] Intussusception was present in our patient, and diagnosis of lipoma was established with pathology before the surgery.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
El-Khalil T, Mourad FH, Uthman S. Sigmoid lipoma mimicking carcinoma: Case report with review of diagnosis and management. GastrointestEndosc 2000;51:495-6.  Back to cited text no. 1
    
2.
Begos DG, Sandor A, Modlin IM. The diagnosis and management of adult intussusception. Am J Surg 1997;173:88-94.  Back to cited text no. 2
    
3.
Târcoveanu E, Chifan M, Veisa E, Epure O, Florea N. Colonic lipoma. Chirurgia (Bucur) 2000;95:353-7.  Back to cited text no. 3
    
4.
Panagiotakis GI, Andreou AG, Petrakis IE, Tzardi M, Daskalogiannaki M, Chalkiadakis GE. Laparoscopic resection of a sigmoid colon lipoma in a young female patient: A case report and review of the literature. Oncol Lett 2017;13:1303-6.  Back to cited text no. 4
    
5.
Ryan J, Martin J, Pollock D. Fatty tumours of the large intestine: A clinicopathological review of 13 cases. BrJSurg 1989;76:793-6.  Back to cited text no. 5
    
6.
Vecchio R, Ferrara M, Mosca F, Ignoto A, Latteri F. Lipomas of the large bowel. Eur J Surg 1996;162:915.  Back to cited text no. 6
    
7.
Tsalis K, Antoniou N, Kalfadis S, Dimoulas A, Dagdilelis AKL, Lazaridis C. Laparoscopic enucleation of a giant submucosal esophageal lipoma. Case report and literature review. Am J Case Rep 2013;14:179.  Back to cited text no. 7
    
8.
Ramdass MJ, Mathur S, Seetahal-Maraj P, Barrow S. Gastric lipoma presenting with massive upper gastrointestinal bleeding. Case Rep Emerg Med 2013;2013:506101.  Back to cited text no. 8
    
9.
Bardaji M, Roset F, Camps R, Sant F, Fernandez-Layos M. Symptomatic colonic lipoma: Differential diagnosis of large bowel tumors. Int J Colorectal Dis 1998;13:1-2.  Back to cited text no. 9
    
10.
Atmatzidis S, Chatzimavroudis G, Patsas A, Papaziogas B, Kapoulas S, Kalaitzis S, et al. Pedunculatedcecallipoma causing colo-colonic intussusception: A rare case report. Case Rep Surg 2012;2012:279213.  Back to cited text no. 10
    
11.
Paskauskas S, Latkauskas T, Valeikaite G, Parseliunas A, Svagzdys S, Saladzinskas Z, et al. Colonic intussusception caused by colonic lipoma: A case report. Medicina (Kaunas) 2010;46:477-81.  Back to cited text no. 11
    
12.
Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, et al. Intussusception of the bowel in adults: A review. World J Gastroenterol 2009;15:407-11.  Back to cited text no. 12
    
13.
Yalamarthi S, Smith RC. Adult intussusception: Case reports and review of literature. Postgrad Med J 2005;81:174-7.  Back to cited text no. 13
    
14.
Reijnen HA, Joosten HJ, de Boer HH. Diagnosis and treatment of adult intussusception. Am J Surg 1989;158:25-8.  Back to cited text no. 14
    
15.
Stubenbord WT, Thorbjarnarson B. Intussusception in adults. Ann Surg 1970;172:306-10.  Back to cited text no. 15
    
16.
M'rabet S, Jarrar MS, Akkari I, Abdelkader AB, Sriha B, Hamila F, et al.Colonic intussusception caused by a sigmoidal lipoma: A case report. Int J Surg Case Rep2018;50:1-4.  Back to cited text no. 16
    
17.
Zenaidi H, Ismail IB, Rekik F, Aziz M, Rebii S, Zoghlami A. Large pedunculated colonic lipoma: A rare cause of colorectal intussusception in adults. Pan Afr Med J 2020;36:200.  Back to cited text no. 17
    
18.
Arora R, Kumar A, Bansal V. Giant rectal lipoma. AbdomImaging 2011;36:545-7.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Previous article  Next article
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed380    
    Printed16    
    Emailed0    
    PDF Downloaded66    
    Comments [Add]    

Recommend this journal