Presentation
Abdominal pain.
Patient Data
Dilated, fluid-filled distal small bowel.
Dilated cecum and appendix.
Intussusception of the hepatic flexure into the transverse colon, which has an "accordion"-like appearance as it is folded over. The lead point is a lipoma, which has a few areas of mild stranding and adjacent foci of air.
Distal colon is decompressed.
Left nephrogram is slightly delayed (I am unsure why).
Case Discussion
Colonic lipomas are benign mesenchymal tumors arising from the bowel wall (submucosal). Most occur in the right colon and are asymptomatic. They uncommonly cause intussusception/obstruction, as in this case.
This lipoma is likely pedunculated, and acted as a lead point for forming the intussusception, with peristalsis propelling it from the upper ascending colon/hepatic flexure into the mid transverse colon. The small foci of air surrounding the lipoma are likely due to ulceration of the overlying mucosa.