Saudi Journal of Gastroenterology
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CASE REPORT Table of Contents   
Year : 2003  |  Volume : 9  |  Issue : 3  |  Page : 145-147
Caecal lipoma causing colo-colonic intussusception


1 Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
2 Department of Radiology, King Khalid University Hospital, Riyadh, Saudi Arabia

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Date of Submission26-Jan-2003
Date of Acceptance18-Jul-2003
 

How to cite this article:
El Tinay OY, Khan IR, Noureldin OH, Al Boukai AA. Caecal lipoma causing colo-colonic intussusception. Saudi J Gastroenterol 2003;9:145-7

How to cite this URL:
El Tinay OY, Khan IR, Noureldin OH, Al Boukai AA. Caecal lipoma causing colo-colonic intussusception. Saudi J Gastroenterol [serial online] 2003 [cited 2020 Oct 23];9:145-7. Available from: https://www.saudijgastro.com/text.asp?2003/9/3/145/33358


Colonic lipomas are benign, slow-growing mesenchymal neoplasms of the large intestine. These are the most common nonepithelial benign neoplasms of the colon. The incidence of colonic lipomas have been reported to be between 0.035% and 4.4% in large autopsy series [1] . The majority of colonic lipomas are small and asymptomatic [2] . Larger lesions may be significant both for symptoms and for radiologic and endoscopic confusion with malignancy [3] . Operative or endoscopic intervention may be required for differentiation from malignant or premalignant lesions. We report a case of colo­colonic intussusception caused by caecal lipoma.


   Case Report Top


A previously well 47-year-old male presented with abdominal pain and diarrhea for three weeks. The pain was colicky, infraumblical and often worse after a meal. There was nausea but no vomiting. He had non-bloody diarrhea. He had anorexia and had lost 7kg over this period. On examination, he had fullness in right upper quadrant. Rectal examination was normal.

Ultrasound examination showed target sign of intussusception [Figure - 1]. Barium enema revealed colonic obstruction in transverse colon. CT scan outlined a soft tissue mass in relation to hepatic flexure with ring-like appearance of contrast around it indicating intussusception [Figure - 2]. Colonoscopy demonstrated a mass at hepatic flexure. Endoscopic biopsy failed to reveal the diagnosis. At laparotomy, colo-colonic intussusception of the ascending colon was found. Right hemicolectomy was performed because it was not possible to reduce the intussusception. The intussusception was caused by a 6.5x4.5cm polypoid mass arising from the cecum [Figure - 3]. Pathological examination showed polypoid mass arising from submucosa of cecum with the stroma containing mostly fatty tissue consistent with submucosal cecal lipoma [Figure - 4], with no evidence of malignancy. The postoperative course was uneventful.


   Discussion Top


Bauer first described lipoma of the colon in 1757 [4] Chung et al in their series of 10658 consecutive colonoscopies identified 16 patients (0.15%) with colonic lipomas [5] . It maybe expected that chance of diagnosis of colonic lipoma will increase with widespread use of colonoscopy and may approach the frequency reported in autopsy series [5].

Colon lipomas are mainly located in the cecum, ascending colon and sigmoid colon in order of decreasing frequencies [6] . They may be submucosal (90% of the cases), subserosal, or intermucosal­serosal.

The symptomatology of lipomas is related to their size and location in the colon [6] . Tumors more than 2cm in diameter may cause symptoms such as pain, hemorrhage, diarrhea, and constipation. Pain may be chronic or recurrent due presumably to recurrent partial intussusception, or may be acute and severe due to traumatic, inflammatory changes in and adjacent to the lipomas, resulting in ulceration [5],[6] .

In practice, distinguishing lipomas from the more common premalignant polyp is often challenging [3]. Barium enema, ultrasound, CT, and colonoscopy can be helpful. At barium enema the most important diagnostic feature of the lipoma is its changing size and shape-squeeze sign [6] . The classic sonographic features of intussusception include the "target" and "doughnut" signs in transverse view and the "psuedokidney" sign in the longitudinal [7] . The use of ultrasound is limited due to the presence of gas in the bowel, which leads to poor transmission, and difficulties in image interpretation. On CT, the lipoma has a uniform appearance and density [5].

Although colonoscopy gives the best exposure of the tumor, it is unlikely to take a biopsy of the adipose tissue lying beneath normal mucosa [6]. Probing with closed biopsy forceps producing a keyhole through which biopsy can be taken is sometimes possible [8] . It remains uncertain whether colonic lipomas will continue to grow or not [9] . Hence it is debatable whether all colonic lipomas should be removed given the small but possible risk of any therapeutic procedure. However, all symptomatic lipoma or those confused with malignancy would require resection. The small pedunculated lipomas can be removed through the colonoscope, and those cases can be saved from surgery [5],[8] . This should be done with care and by experienced colonoscopists because of the potential risk of perforation [5] . For lesions where malignancy is strongly suspected, formal open resection is indicated [10] . Whenever a lipoma is confidently diagnosed pre-operatively, laparoscopic assisted resection is the operation preferred [5],[11],[12] . In our case right hemicolectomy was done for it was not possible to reduce the intussusception preoperatively and also due to the high suspicion of malignancy. Primary colonic cancer has contributed to two thirds of colonic intussusception in adults. Therefore hemicolectomy without reduction has been advocated [12] .

In conclusion, colonic lipoma is much less common than adenoma and is an uncommon cause for intestinal obstruction and hemorrhage. Clinical recognition and understanding of this lesion is vital both in treatment of symptoms and distinction from premalignant lesions. Endoscopy and radiology may help in differentiation. Resection can be done either through endoscope or by conventional surgery.

 
   References Top

1.Mayo CW, Pagtalunan GJG, Brown BJ. Lipoma of the alimentary tract. Surgery 1962; 53: 598-603.  Back to cited text no. 1    
2.Bombi JA. Polyps of the colon in Barcelona, Spain; an autopsy study. Cancer 1988; 61: 1472-6.  Back to cited text no. 2  [PUBMED]  
3.Franc-Law JM, Begin LR, Vasilevsky C-A, Gordon PH. The dramatic presentation of colonic lipomata: report of two cases and review of the literature. Am Surg 2001; 67: 491-4.  Back to cited text no. 3    
4.Haller JD, Roberts TW. Lipomas of the colon: a clinico-pathologic study of 20 cases. Surgery 1964; 55: 773-81. (Cross-reference for Bauer report).  Back to cited text no. 4  [PUBMED]  
5.Chung YFA, Ho Y-H, Nyam DCNK, Leong AFPK, Seow-Choen F. Management of colonic lipomas. Aust N Z J Surg 1998; 68: 133-5.  Back to cited text no. 5    
6.Alponat A, Kok KYY, Gob PMY, Ngoi SS. Intermittent subacute intestinal obstruction due to a giant lipoma of the colon: a case report. Am Surg 1996; 62: 918-21.  Back to cited text no. 6    
7.Wissbage DL, Scheible W, Leopold JR. Ultrasonic appearance of adult intussusception. Radiology 1997; 124: 791-2.  Back to cited text no. 7    
8.Van Heel DA, Panos MZ. Colonoscopic appearances and diagnosis of intussusception due to large bowel lipoma. Endoscopy 1999; 31: 508.  Back to cited text no. 8  [PUBMED]  
9.Welin S, Yoker J, Spratt JS Jr. The rates and patterns of growth of 375 tumors of the large intestine and rectum observed serially by double contrast enema study (Malmo) technique. AJR 1963; 90: 673-86.  Back to cited text no. 9    
10.Dolan K, Khan S, Goldring JR. Colo-colonic intussusception due to lipoma. J R Soc Med 1998; 91: 94.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Amal Abdulkarim. Endoscopic removal of sigmoid lipoma causing intussusception Saudi J of gastroenterol 2001; 7: 34-6  Back to cited text no. 11    
12.Hackam DJ, Saibil F,Wilson S, Litwin D. Laparoscopic management of intussusception caused by colonic lipomata: a case report and review of literature. Surg laparoscopic Endosc 1996: 6: 155-9.  Back to cited text no. 12    

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Correspondence Address:
Omer Yousif El Tinay
Department of Surgery, King Khalid University Hospital, P.O. Box 7805, Riyadh 11472
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19861820

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