University of Miami, JFK Medical Center Palm Beach West Palm Beach, FL, United States
Peter Stawinski, MD1, Karolina Dziadkowiec, MD1, Aviv Katz, DO2 1University of Miami, JFK Medical Center Palm Beach, West Palm Beach, FL; 2University of Miami, JFK Medical Center Palm Beach, Atlantis, FL
Introduction: Abdominal pain secondary to intussusception is an uncommon presentation of abdominal pain in the emergency department. Intussusception is defined as the prolapse of proximal segment of the intestine into the distal segment. Patients present with colicky abdominal pain that is localized to one portion of the abdomen with accompanying nausea and vomiting. In adult patients, the underlying cause is usually a structural lesion, in this case a large ileal lipoma. Medical intervention is required because such lesions can have malignant etiology. We present a case of a small bowel intussusception secondary to a large gastrointestinal lipoma.
Case Description/Methods: A 43-year-old woman was admitted to the emergency department with progressively worsening, acute colicky abdominal pain of 3 week duration. Her pain was localized to the right lower quadrant of the abdomen and did not respond to analgesia and antispasmodic medications. On admission the patient was afebrile, hemodynamically stable with a blood pressure of 126/68 mmHg and with a regular pulse of 86/min. Upon clinical evaluation of the abdomen, there were no peritoneal signs. Laboratory investigations showed an elevated white blood cell count of 12,000/μl. Computed tomography (CT) scan of the abdomen with oral and intravenous (IV) contrast showed a ileo-ileal bowel intussusception with a intraluminal soft tissue mass with negative attenuation consistent with a lipoma.
Based on this imaging finding, a colonoscopy was completed which showed a large partially obstructing nonbleeding malignant appearing mass proximal to the ileocecal valve (Fig 1.). Colorectal surgery was consulted, a laparoscopic exploration with resection of the 2x3cm lipoma and a resection of 5cm of small bowel was performed with end to end anastomosis. Histological analysis of the mass showed an ulcerated lipoma without evidence of malignancy. The postsurgical hospital course was uneventful and the patient was discharged days later.
Discussion: Intussusception in adult patients, a rare occurrence accounting for only 5-10% of all reported cases. In an ileo-ileal intussusception, a lipoma is often the lead point which is responsible for telescoping a portion of the ileum causing lymphatic and venous congestion resulting in intestinal edema. A lipoma on CT imaging presents as a characteristic fatty densitometric area with smooth margins. This case highlights the importance of considering a gastrointestinal lipoma as a rare cause of intussusception in adult patients.
Figure: A large ulcerated lipoma located in the ileum.
Disclosures: Peter Stawinski indicated no relevant financial relationships. Karolina Dziadkowiec indicated no relevant financial relationships. Aviv Katz indicated no relevant financial relationships.
Peter Stawinski, MD1, Karolina Dziadkowiec, MD1, Aviv Katz, DO2. P2302 - Adult Ileo-ileal Intussusception Induced by a Large Lipoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.