Colonic intussusception - colonic lipoma

Case contributed by Dr Eid Kakish

Presentation

One-month history of dull intermittent right-sided lower abdominal pain, chronic constipation, bloating and lower abdominal fullness

Patient Data

Age: 35 years
Gender: Female
Ultrasound

US abdomen

RLQ ultrasound shows a rather rounded lesion with alternating echogenic and hypoechoic concentric bands and minimal internal vascularity on color Doppler interrogation.

Ultrasound findings are suggestive of intussusception.

CT

CT abdomen

Large ovoid intraluminal fatty lesion in the proximal transverse colon, resulting in ascending colocolic and ileocolic intussusception. This lesion demonstrates internal septal enhancement after the administration of intravenous contrast, with no definite enhancing soft-tissue components.

A delayed prone scan obtained with rectal contrast revealed good luminal opacification of the left hemicolon and clearly delineates the leading point of intussusception. No signs of large bowel obstruction.

The ascending and proximal transverse colonic walls appear to be burdened by extensive diverticular disease, likely secondary to chronic increased intraluminal pressure and constipation. No signs of acute diverticulitis.

No suspicious enhancing colonic wall lesions.

Extensive reactive mesenteric lymphadenopathy in the right iliac fossa, associated with a small amount of surrounding fat stranding. No free fluid or localized collections.

X-ray

CT Topogram with rectal contrast

CT topogram with rectal contrast clearly shows a filling defect in the proximal and mid transverse colon with almost absent right hemicolonic gas.

Partial colectomy showing the colonic lipoma described on imaging.

Case Discussion

Colonic intussusception in an adult is usually secondary to a malignant cause. However, the most common benign cause of colonic intussusception in adults are colonic lipomas.

Colonic lipomas are usually solitary submucosal lesions that may be sessile or pedunculated. 90% of these are found in the colonic submucosa while the rest originate from the colonic serosa. They favor the right hemicolon and are more common in women.

On CT scan, they have a typical appearance due to fat attenuation and are often incidentally seen on imaging or endoscopy.

They are normally asymptomatic, unless they are the lead point for intussusception, then they present with abdominal pain. Other presentations may include nausea, vomiting, lower GI bleeding, alternating bowel habit and bowel obstruction.

A variety of treatments have been proposed, including a partial colectomy, segmental resection, local excision or endoscopic resection of small lesions.

Malignant causes for large bowel intussusception include adenocarcinoma, metastasis or lymphoma. Adhesions and motility disorders may also result in intussusception.

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Case information

rID: 85757
Published: 8th Jan 2021
Last edited: 9th Mar 2021
Inclusion in quiz mode: Included
Institution: MedRay - Jordan

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