J Korean Surg Soc.  2009 Jul;77(1):59-63. 10.4174/jkss.2009.77.1.59.

A Rare Ileal Intussusception Caused by a Lipoma of the Ileum

• Kee SK
• Kim JO
• Kwon OK
• Nam SY
• Byun KH
• Kim BK
• Kim JY

• KMID: 1464944
• DOI: http://doi.org/10.4174/jkss.2009.77.1.59

Abstract

Adult intussusception is a rare disease and it differs from childhood intussusception in its presentation, cause and treatment. Most of the cases have an underlying lesion within the intussusception that requires surgical resection. Making the diagnosis can be delayed because of the nonspecific and chronic symptoms, and many cases are diagnosed during performance of emergency laparotomy for treating the obstructive symptoms. A computed tomography (CT) scan is most useful for making the diagnosis of adult intussusception and is helpful in revealing the underlying lesion, although a barium enema can help to diagnose colonic intussusceptions. Surgical resection remains the recommended treatment for nearly all cases, but there is controversy about whether or not the intussusception should be initially reduced before resection. Gastrointestinal lipomas are rare benign tumors that can occur anywhere along the gut, and the small bowel is the second most common site for gastrointestinal lipomas after the colon. Intussusception of the ileum by a lipoma is very rare. We report here on a case of ileo-ileal intussusception that was caused by a lipoma of the ileum in a 35-year-old man who complained of abdominal pain of one week duration. The diagnosis of an ileo-ileal intussusception caused by a lipoma of the ileum was suspected preoperatively according to the typical CT findings, so we tried to initially reduce the intussusception during laparotomy. But manual reduction was impossible due to the edema of the lesion, and an ileum of some length had to be resected.

Keyword

Gastrointestinal lipoma; Intussusception; Ileum

MeSH Terms

Abdominal Pain
Adult
Barium
Colon
Edema
Emergencies
Enema
Humans
Ileum
Intussusception
Laparotomy
Lipoma
Rare Diseases
Barium

Figure

• 

  Fig. 1 (A) The plain abdominal films show the localized ileus in the lower abdomen. (B) The contrast-enhanced CT scan demonstrates an ileo-ileal intussusception caused by a mass of the ileum. (Left) The CT scan shows a homogeneous intaluminal mass with fat attenuation in the ileum (arrow). (Right) The CT scan shows a target-like appearance. The intussusceptum (black arrowhead), with an accompanying complex of mesenteric fat and blood vessels (arrow), is surrounded by the thick-walled intussuscipiens (white arrowhead). (C) Ultrasonography shows the target sign and an echogenic intraluminal mass (arrow) on the axial scan, and a sausage-shaped lesion on the longitudinal scan.

• 

  Fig. 2 Gross and microscopic findings of the specimen. (A) Photograph of the resected ileum shows a pedunculated polypoid mass, measuring 4×3×2 cm, as the lead point of the intussusception. The mass had a soft to firm, smooth surface, and the surrounding ileum and the overlying mucosa of the mass were infarcted. (B) Microscopically, a well-defined adipose mass was noted at the muscular layer and the mucosa was infarcted (H&E, ×10). Inset shows the magnified view of the lesion (H&E, ×40). M = mucosa; S.M = submucosa; M.L = muscular layer.

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