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CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 60-62

Adult intussusceptions in descending colon: An uncommon occurrence


1 Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Surgery, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
3 Department of Radiology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
4 Department of Surgical Oncology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

Date of Web Publication22-Mar-2018

Correspondence Address:
Dr. Rashmi Patnayak
Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_2_18

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  Abstract 


Intussusception is a rare event in adults which constitutes 1–3% of all cases of intestinal obstruction. Malignant etiology as causes of intussusception is more common in large bowel accounting for 60–65% cases. Intussusception due to colonic lipoma is rare. The present case is a 45-year-old woman who had a polypoidal growth in the descending colon. She was operated and the growth was histopathologically diagnosed as lipoma. Though rare, colonic lipoma should be considered as a probable etiology for intussusceptions.

Keywords: Colonic lipoma, descending colon, intussusceptions, intestinal obstruction


How to cite this article:
Patnayak R, Samal D, Pattnaik A, Panda AK, Mahapatra D, Jena A. Adult intussusceptions in descending colon: An uncommon occurrence. J NTR Univ Health Sci 2018;7:60-2

How to cite this URL:
Patnayak R, Samal D, Pattnaik A, Panda AK, Mahapatra D, Jena A. Adult intussusceptions in descending colon: An uncommon occurrence. J NTR Univ Health Sci [serial online] 2018 [cited 2020 Mar 29];7:60-2. Available from: http://www.jdrntruhs.org/text.asp?2018/7/1/60/228144




  Introduction Top


Intussusception in adults is rare. It constitutes <5% of all cases of intussusception and 1–3% of all cases of intestinal obstruction. In intussusception, a proximal segment of bowel telescopes invaginates into an adjacent distal segment. It usually involves a lesion in the bowel wall or an irritant in its lumen serving as a lead point which changes the normal peristaltic pattern and initiates the invagination leading to intussusception.[1]

Intussusception can be primary or secondary. Primary intussusception is idiopathic whereas in secondary a lead point is identified. The causes of secondary intussusception can be benign, malignant, or iatrogenic. Malignant etiology as causes of intussusception is more common in large bowel accounting for 60–65% of cases.[1]

Colonic lipoma is a benign tumor of adipocytic origin with reported incidence of 0.035–4.4% in large intestine.[2] Colonic intussusception secondary to colonic lipomas is rare in English literature.[1] We present one such case.


  Case History Top


A 45-year-old woman presented with complaint of bloating and abdominal pain for 1 month. On examination, she had minimal weight loss. Her routine investigations were within normal limit. She underwent ultrasonographic examination of the whole abdomen which revealed short-segment sigmoid colon annular wall thickening with invagination of proximal loop into distal segment. There was mild proximal colonic dilatation. In colonoscopy, there was a polypoidal growth with overlying ulceration present in the sigmoid and descending colon [Figure 1]a. In sigmoidoscopy, sigmoid colon intussusception was noted [Figure 1]b and [Figure 1]c. Her computed tomography report suggested submucosal lipoma in descending colon with near complete obliteration of lumen.
Figure 1: (a) Colonoscopy showing presence of growth in descending colon with ulceration. (b, c) Colonoscopy showing intussusception noted at sigmoid colon. (d) Gross picture of resected colon with lipoma

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The Department of Pathology received resected segment of large intestine with presence of polypoidal growth measuring 4 cm × 3 cm in its luminal aspect. The cut section of the growth was yellowish [Figure 1]d. Histopathology of the growth showed colonic mucosa with focal ulceration. The lesion predominantly composed of lobules of mature adipocytes [Figure 2]a, [Figure 2]b, [Figure 2]c. It was diagnosed as lipoma. The patient had an uneventful postoperative period. She is doing well after 6 months of follow-up.
Figure 2: (a) Histopathology of colonic lipoma with colonic mucosa (hematoxylin and eosin × 100). (b, c) Histopathology showing lobules of mature adipose tissue separated by fibrous septae (hematoxylin and eosin × 100)

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  Discussion Top


Lipomas may occur throughout the intestinal tract. Colonic lipoma is a rare submucosal benign tumor of the gastrointestinal tract.[2] The reported incidence ranges from 0.035% to 4.4%. Commonest location of colonic lipomas is in the right hemicolon. They are predominantly noted in ascending colon (61%), followed by descending colon (20.1%), transverse colon (15.5%), and in the rectum (3.4%). Multiple lipomas have been shown in 10–20% of the patients.[2] Adult intussusception is a rare clinical entity. It comprises only 1–5% of all cases presenting as bowel obstruction. Adult colonic intussusception is most often caused by lipomas. Few cases of lipoma in descending colon such as ours have been previously reported in the literature.[2],[3]

They are mainly found in females aged between 50 and 60 years. Generally, they present as sessile polyps. They originate from the submucosa with an intact mucosa. Colonic lipomas are usually asymptomatic. They are detected incidentally during colonoscopy, surgery, or autopsy.[1] Signs and symptoms are more generally related with lipomas larger than 2 cm. The usual symptoms are abdominal pain, constipation, rectal hemorrhage, and rarely intussusception.[2],[3] The present case is one such case of colonic lipoma where the patient had intussusception.[1]

Various imaging methods and endoscopic interventions may not provide the final diagnosis. In cases with large colon lipomas, sometimes it is difficult to differentiate it from malignant lesion prior to surgery. Histopathological evaluation is required to make a definitive diagnosis.[2]

Surgical resection remains the treatment of choice of intussusception in view of the uncertain etiology and diagnosis and high incidence of malignancy.[2],[4],[5] Till 2015, less than 50 cases of colonic intussusception secondary to colonic lipomas have been reported in the English language literature.[1] Gupta et al., in their analysis of 38 adult intussusception cases, found three cases of colonic lipoma which underwent surgical resection.[6]

This case highlights the histopathological importance in the diagnosis of colonic lipoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mohamed M, Elghawy K, Scholten D, Wilson K, McCann M. Adult sigmoidorectal intussusception related to colonic lipoma: A rare case report with an atypical presentation. Int J Surg Case Rep 2015;10:134-7.  Back to cited text no. 1
[PUBMED]    
2.
Bagherzadeh Saba R, Sadeghi A, Rad N, Safari MT, Barzegar F. Colonic intussusception in descending colon: An unusual presentation of colon lipoma. Gastroenterol Hepatol Bed Bench 2016;9(Suppl. 1):S93-6.  Back to cited text no. 2
    
3.
Allos Z, Zhubandykova D. Large benign submucosal lipoma presented with descending colonic intussusception in an adult. Am J Case Rep 2013;14:245-9.  Back to cited text no. 3
[PUBMED]    
4.
Shenoy S. Adult intussusception: A case series and review. World J Gastrointest Endosc 2017;9:220-7.  Back to cited text no. 4
[PUBMED]    
5.
Sarma D, Prabhu R, Rodrigues G. Adult intussusception: A six-year experience at a single center. Ann Gastroenterol 2012;25:128-32.  Back to cited text no. 5
    
6.
Gupta RK, Agrawal CS, Yadav R, Bajracharya A, Sah PL. Gastrointestinal (GI) Unit, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Intussusception in adults: Institutional review. Int J Surg 2011;9:91-5.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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