Intussusception is defined as invagination of the proximal bowel into the distal segment,
which produces a telescoping effect. Colonic intussusception occurs in fewer than
5 % of the adult population and most patients have a pathological lead point [1]. Colonic lipomas are relatively rare and frequently asymptomatic. However, large
lipomas are more likely to cause complications, such as abdominal pain, lower gastrointestinal
bleeding, obstruction or, rarely intussusception [2]
[3]
[4]. We present a patient with colocolonic intussusception due to lipoma, with classical
clinical, endoscopic, and radiographic features.
A 46-year-old man presented to our hospital with intermittent periumbilical pain and
passage of fresh blood via the rectum for 10 days. Colonoscopy revealed a 6-cm mass
lesion with congestive, hemorrhagic, and ulcerative mucosa at the descending colon,
near the splenic flexure ([Fig. 1]). A reformatted coronal view of an abdominal computed tomography (CT) scan showed
a fat-containing, pedunculated soft-tissue mass, with a diameter of approximately
6 × 3.5 × 3.5 cm, which was causing colocolonic intussusception ([Fig. 2]). Virtual colonoscopy demonstrated a three-dimensional stalked mass lesion, which
was similar in appearance to the lesion observed with colonoscopy ([Fig. 3]). A double-contrast lower gastrointestinal series showed a well-defined pedunculated
mass with intussusception over the splenic flexure (not shown). The patient underwent
left hemicolectomy and a 6 × 5 × 4 cm, oval-shaped pedunculated tumor was found over
the descending colon near the splenic flexure, with colocolonic intussusception associated
with total lumen obstruction. The surgical specimen revealed a yellowish, soft-cut
surface with scattered yellowish nodular lesions ([Fig. 4]). Mesocolic tissue with reactive lymph nodes was also obtained. Histopathologic
examination showed nests of proliferative mature lipocytes with mucosal ulceration
(not shown). The morphological picture was a submucosal lipoma of the colon with focal
ulcers.
Fig. 1 Endoscopic view of the colon shows a 6-cm mass lesion at the descending colon near
the splenic flexure, which has congestive, hemorrhagic, and ulcerative mucosa.
Fig. 2 A reformatted coronal view of an abdominal computed tomography scan shows a fat-containing,
pedunculated soft-tissue mass, approximately 6 × 3.5 × 3.5 cm in diameter, which was
causing colocolonic intussusception (arrow).
Fig. 3 Virtual colonoscopy demonstrates a three-dimensional stalked mass lesion, approximately
6 × 3.5 × 3.5 cm in diameter, over the descending colon.
Fig. 4 Gross appearance of the resected specimen reveals a 6 × 5 × 4 cm, oval-shaped pedunculated
tumor over the descending colon near the splenic flexure, with colocolonic intussusception
associated with total lumen obstruction.
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