University of Iowa Hospitals and Clinics Iowa City, Iowa
Yazan Hasan, MBBS1, Mahmoud Soubra, MD2; 1University of Iowa Hospitals and Clinics, North Liberty, IA; 2University of Iowa Hospitals and Clinics, Iowa City, IA
Introduction: Colo-colonic intussusception has been rarely reported in the literature.[1, 2] Most causes are due to adhesions, motility disorders, colonic masses or inflammatory conditions. Colonic lipomas are benign non-epithelial adipocyte hyperplasia of the gastrointestinal tract and are the second most common benign colon tumors. Rarely, they can cause complications such as abdominal pain, hematochezia, intestinal obstruction, or intussusception particularly if the lipoma is larger than 2 cm.
Methods: A 57 year-old-man presented to the outpatient clinic with intermittent abdominal pain and hematochezia for 2 months. CT abdomen revealed a colo-colonic intussusception in the descending colon (Figure A) with a 3 cm mass acting as a leading point (Figure B). Colonoscopy showed a 3 cm polypoid lesion with surface ulceration (Figure C). This was probed with a biopsy forceps and had a positive pillow sign consistent with a lipoma. As the mass was large and causing symptoms, a decision was made to proceed with endoscopic snare resection using blended cautery current (ENDO CUT Effect 2; Erbe USA Inc, Marietta, GA). Histologic examination was consistent with benign lipoma. Post procedure, he developed abdominal pain, fever and leukocytosis without evidence of perforation on repeat imaging in keeping with post-polypectomy electrocoagulation syndrome. He was managed conservatively with good response and discharged home 48 hours later. Discussion: Colo-colonic intussusception contributes to 17% of all intestinal intussusceptions in adults [2, 4]. The clinical presentation is highly variable . Colo-colonic intussusception due to colonic lipomas is rare with a reported incidence between 0.035% and 4.4% . The majority of cases occur in the right colon. Most patients with colonic lipomas are asymptomatic and are incidentally found during colonoscopy. Only 25% of patients develop symptoms . Due to their intramural location, lipomas can serve as a leading point for intussusceptions . Management depends on the size of the lipoma and the presenting symptoms. However, there is no proper guidelines to determine the size where endoscopic or surgical resection should be performed. Historically, most patients with large colonic lipomas causing symptoms have undergone surgical resection. More recently, several successful endoscopic methods have been reported with excellent results and low complication rate [8-10].
Disclosures: Yazan Hasan indicated no relevant financial relationships. Mahmoud Soubra indicated no relevant financial relationships.