Colo-colonic intussusception secondary to a giant lipoma

Intestinal intussusception is rare in adults, with colo-colonic intussusception accounting for 17%. While most cases are due to malignant lesions, lipomas are among the benign causes. Lipoma of the large intestine accounts for only 5% of all gastrointestinal tumors. They are typically asymptomatic. However, giant lipomas (>5 cm) are symptomatic in over 75% of cases. Due to their submucosal location, they can serve as the leading point for intussusception. Abdominal pain is the most common symptom. Early diagnosis is challenging because of nonspecific symptoms and lipoma is often mistaken for a malignant or adenomatous polyp. Treatment is endoscopic, laparoscopic, or open, depending on the size, location, and preoperative complications. We herein present a rare case of giant lipoma causing a colo-colonic intussusception.

A 44-year-old male patient presented to the emergency department with acute, severe, diffuse abdominal pain, rigidity, and distention evolving for 12 h. The patient reported a history of acute and self-limiting abdominal pain. Abdominal and pelvic CT showed a mass in the proximal transverse colon suggestive of colo-colonic intussusception. Colonoscopy revealed a large submucosal mass filling the colonic lumen but permitting transposition of the scope. Due to swelling of the colonic wall and unsuccessful desinvagination, urgent laparoscopic segmental colon resection was performed. Histology revealed a 16 ×3 cm submucosal lipoma without signs of malignancy. The patient was discharged 5 days after surgery.

Adult colonic intussusception is a rare but challenging condition to diagnose in a timely manner. A high index of suspicion and CT and colonoscopy can result in prompt diagnosis. Treatment usually requires segmental resection of the involved bowel. Therefore, collaboration between surgeons and endoscopists is required. This case supports the notion that colo-colonic intussusception should be studied by endoscopy before resection if the underlying etiology is suspected to be benign, is unknown, or if the resection is deemed to be massive.