Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an Adult

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Abstract

Introduction:

Colocolic intussusception in adults is uncommon and poses both a diagnostic and therapeutic dilemma. The association of an underlying malignancy necessitates a preoperative confirmation of diagnosis. The presenting features are variable. Hence contrast enhanced computed tomography of the abdomen is pivotal for diagnosis. An en bloc resection of the specimen in accordance with standard oncological principles is the mainstay of treatment.

Case report:

A case of colocolic intussusception in an adult is presented to highlight the difficulties in preoperative diagnosis and in selecting the best surgical option for treatment.

Conclusion:

Adult bowel intussusception is a diagnostic dilemma with preoperative diagnosis being the biggest challenge. CT scan of the abdomen is an excellent diagnostic modality with high diagnostic accuracy. Explorative laparotomy with en bloc resection is mainstay of treatment in adults.

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Most cited references 10

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Adult intussusception.

T. Azar, D L Berger (1997)

The objectives were to review adult intussusception, its diagnosis, and its treatment. Adult intussusception represents 1% of all bowel obstructions, 5% of all intussusceptions, and 0.003%-0.02% of all hospital admissions. Intussusception is a different entity in adults than it is in children. The records of all patients 18 years and older with the postoperative diagnosis of intussusception at the Massachusetts General Hospital during the years 1964 through 1993 were reviewed retrospectively. The 58 patients were divided into those with benign enteric, malignant enteric, benign colonic, and malignant colonic lesions associated with their intussusception. The diagnosis and treatment of each were reviewed. In 30 years at the Massachusetts General Hospital, there are 58 cases of surgically proven adult intussusception. The patients' mean age was 54.4 years. Most patients presented with symptoms consistent with bowel obstruction. There were 44 enteric and 14 colonic intussusceptions. Ninety-three percent of the intussusceptions were associated with a pathologic lesion. Forty-eight percent of the enteric lesions were malignant and 52% were benign. Forty-three percent of the colonic lesions were malignant and 57% were benign. Intussusception occurs rarely in adults. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. Computed tomography scanning proved to be the most useful diagnostic radiologic method. The diagnosis and treatment of adult intussusception are surgical. Surgical resection of the intussusception without reduction is the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy.

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Intussusception of the bowel in adults: a review.

Anneza Yiallourou, Nikolaos Dafnios, Ioannis Vassiliou … (2009)

Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. However, bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Secondary intussusception is caused by organic lesions, such as inflammatory bowel disease, postoperative adhesions, Meckel's diverticulum, benign and malignant lesions, metastatic neoplasms or even iatrogenically, due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusceptions with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected. Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.

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Intussusception in adults: institutional review.

A. H. Aufses, Thomas D. Cunningham, Jane L Eisen (1999)

Intestinal intussusception in the adult is a rare entity that differs greatly in etiology from its pediatric counterpart. Controversy remains regarding the optimal management of this problem in the adult patient. The purpose of this study was to determine the cause(s) of intussusception and to determine the role of intestinal reduction in the management of intussusception in adults. A retrospective review performed at The Mount Sinai Medical Center identified 27 patients, 16 years and older, with a diagnosis of intestinal intussusception. Data related to presentation, diagnosis, treatment, and pathology were analyzed. There were 13 males and 14 females. The median age of the group was 52 years with a range of 16 to 90 years. Abdominal pain was the most common presenting complaint. A preoperative diagnosis was suspected in 11 of 27 patients (40%). There were 22 small bowel lesions and 5 colonic lesions. A pathologic cause was identified in 85% of patients with 8 of 22 (36%) small bowel and 4 of 5 (80%) of large bowel lesions being malignant. All small bowel cancers represented metastatic disease and all large bowel malignancies were primary adenocarcinomas. The median age of patients with malignant disease was 60 years; it was 44 years for those with benign disease. Operative treatment consisted of resection alone in 58% of patients and resection after reduction in 42%. Three patients were treated nonoperatively. Our data support a selective approach to the operative treatment of intussusception in adults. Colonic lesions should not be reduced before resection because they most likely represent a primary adenocarcinoma. Small bowel intussusception should be reduced only in patients in whom a benign diagnosis has been made preoperatively or in patients in whom resection may result in short gut syndrome.

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Author and article information

Journal

Journal ID (nlm-ta): Med Arch

Journal ID (iso-abbrev): Med Arch

Journal ID (publisher-id): Medical Archives

Title: Medical Archives

Publisher: Academy of Medical Sciences of Bosnia and Herzegovina

ISSN (Print): 0350-199X

ISSN (Electronic): 1986-5961

Publication date (Print): October 2020

Volume: 74

Issue: 5

Pages: 393-395

Affiliations

Department of Surgery, D.Y.Patil University School of Medicine. Navi Mumbai, India.

Author notes

Corresponding author:Ketan Vagholkar. Department of Surgery, D.Y.Patil University School of Medicine. Navi Mumbai 400706. MSIndia perolidua@ 123456gmail.com ORCID ID: https://orcid.org/0000-0002-3824-0531

Article

DOI: 10.5455/medarh.2020.74.393-395

PMC ID: 7780799

SO-VID: 96a3682f-47ac-4972-a27b-64d8cbdeaa06

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an Adult

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Abstract

Introduction:

Case report:

Conclusion:

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IOP Publishing: Coronavirus

Most cited references 10

Adult intussusception.

Intussusception of the bowel in adults: a review.

Intussusception in adults: institutional review.

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