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Pedunculated lipoma causing colo-colonic intussusception: a rare case report.

Mouaqit O, Hasnai H, Chbani L, Oussaden A, Maazaz K, Amarti A, Taleb KA - BMC Surg (2013)

Bottom Line: Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon.CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall.Surgical resection remains the treatment of choice and produces an excellent prognosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Surgery Departement, University Hospital Hassan II, BP 1893; Km 2,200, Sidi Harazem Road, Fez 30000, Morocco. mouaqit.ouadii@gmail.com.

ABSTRACT

Background: Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy.

Case presentation: A 55-year old man visited our emergency department with severe abdominal pain, multiple episodes of vomiting, abdominal distension. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign, suggestive of intussusception. Surgery revealed a hard elongated mass in the right colon wihch telescoped in the transverse colon and caused colo-colonic intussusception. Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.

Conclusion: A large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy. CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall. Surgical resection remains the treatment of choice and produces an excellent prognosis.

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Resected specimen demonstrating fatty consistency.
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Figure 3: Resected specimen demonstrating fatty consistency.

Mentions: A 55-year old man presented with a three day history of colicky abdominal pain and bilious vomiting. The patient had no past history of peptic ulcer disease, alteration in bowel habits, melena or weight loss. On examination, he was apyrexial and hemodynamically stable. His abdomen was distended with localized tenderness in the right iliac fossa and no palpable abdominal masses; bowel sounds were hyperaudible. Initial A rectal examination revealed no masses or blood. The laboratory findings on admission were as follows: normal red blood cell count (4420000/mm), normal white blood cell count (10200/mm3), and normal platelet count (151000/mm3). The total protein, and serum creatinine levels were within the normal range, as were the serum carcinoembryonic antigen and cancer antigen19-9 levels. Abdominal CT showed a target sign- or sausage-shaped lesion typical of an intussusception that varied in appearance relative to the slice axis. More head-side scans showed a low-density homogenous mass measuring 3 cm that was considered to be the leading point for the invagination (Figure 1). These findings led to a diagnosis of intussusceptions induced by a lipoma. Colonoscopy was performed to assess the lesion further and attempt to reduce the intussusception however when this was not possible. The patient was transferred to the operating room for exploratory laparoscopy, which revealed the presence of a colo-colonic intussusception in the right colon. Because of compromised perfusion and swelling of his colonic wall and because of an unsuccessful attempt at manual desinvagination, a right hemicolectomy was performed. The continuity single-layer end-to-end ileotransverse anastomosis. The postoperative period was uneventful and the patient was discharged on the sixth postoperative day. Macroscopic assessment of the resected specimen showed the presence of a round pedunculated colonic polypoid tumor of 3 × 3 × 4,5 cm in size with the features of lipoma, causing intussusception of the ascending colon into transverse colon (Figures 2 and 3). The histological examination revealed mature fat cells, connective tissue, and scattered blood vessels within the removed submucosal mass (Figure 4). There was no evidence of dysplasia or malignancy.


Pedunculated lipoma causing colo-colonic intussusception: a rare case report.

Mouaqit O, Hasnai H, Chbani L, Oussaden A, Maazaz K, Amarti A, Taleb KA - BMC Surg (2013)

Resected specimen demonstrating fatty consistency.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3818566&req=5

Figure 3: Resected specimen demonstrating fatty consistency.
Mentions: A 55-year old man presented with a three day history of colicky abdominal pain and bilious vomiting. The patient had no past history of peptic ulcer disease, alteration in bowel habits, melena or weight loss. On examination, he was apyrexial and hemodynamically stable. His abdomen was distended with localized tenderness in the right iliac fossa and no palpable abdominal masses; bowel sounds were hyperaudible. Initial A rectal examination revealed no masses or blood. The laboratory findings on admission were as follows: normal red blood cell count (4420000/mm), normal white blood cell count (10200/mm3), and normal platelet count (151000/mm3). The total protein, and serum creatinine levels were within the normal range, as were the serum carcinoembryonic antigen and cancer antigen19-9 levels. Abdominal CT showed a target sign- or sausage-shaped lesion typical of an intussusception that varied in appearance relative to the slice axis. More head-side scans showed a low-density homogenous mass measuring 3 cm that was considered to be the leading point for the invagination (Figure 1). These findings led to a diagnosis of intussusceptions induced by a lipoma. Colonoscopy was performed to assess the lesion further and attempt to reduce the intussusception however when this was not possible. The patient was transferred to the operating room for exploratory laparoscopy, which revealed the presence of a colo-colonic intussusception in the right colon. Because of compromised perfusion and swelling of his colonic wall and because of an unsuccessful attempt at manual desinvagination, a right hemicolectomy was performed. The continuity single-layer end-to-end ileotransverse anastomosis. The postoperative period was uneventful and the patient was discharged on the sixth postoperative day. Macroscopic assessment of the resected specimen showed the presence of a round pedunculated colonic polypoid tumor of 3 × 3 × 4,5 cm in size with the features of lipoma, causing intussusception of the ascending colon into transverse colon (Figures 2 and 3). The histological examination revealed mature fat cells, connective tissue, and scattered blood vessels within the removed submucosal mass (Figure 4). There was no evidence of dysplasia or malignancy.

Bottom Line: Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon.CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall.Surgical resection remains the treatment of choice and produces an excellent prognosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Surgery Departement, University Hospital Hassan II, BP 1893; Km 2,200, Sidi Harazem Road, Fez 30000, Morocco. mouaqit.ouadii@gmail.com.

ABSTRACT

Background: Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy.

Case presentation: A 55-year old man visited our emergency department with severe abdominal pain, multiple episodes of vomiting, abdominal distension. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign, suggestive of intussusception. Surgery revealed a hard elongated mass in the right colon wihch telescoped in the transverse colon and caused colo-colonic intussusception. Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.

Conclusion: A large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy. CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall. Surgical resection remains the treatment of choice and produces an excellent prognosis.

Show MeSH
Related in: MedlinePlus