35 year old male patient complains of pain in abdomen on and off for a few months.
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Evidence of a well defined intraluminal lesion seen in the distal jejunal-proximal ileal loops measuring approx. 2.4 x 1.3 cm in size. Intussusception of the approx 6 cm length of the small bowel is noted with the above described fat density lesion (lipoma ) seen at the tip of intussusceptum. There is no evidence of dilatation of the proximal ileal loops.There was progression of intusussuception during the scan. On plain sections the lipoma is present in jejunal loops which is seen to progress distally into the ileal loops on subsequent images of arterial, venous and delayed phases.
Intusussception is invagination one bowel segment into adjacent bowel segment. Rare in adults.
Types - ileocolic, colocolic, enteroenteric, or jejunogastric.
Causes in adults are generally mechanical. Lead points involving colon are usually malignant (carcinoma, lymphoma) and of small bowel tend to be benign like lipoma, polyp, Meckel's diverticulum, sprue or from lymphoid hyperplasia secondary to viral infection.
Gastrointestinal lipoma may be submucosal or subserosal. Intestinal intussusception by lipoma is uncommon. Rare when lipoma located in small intestine. Found in the ileum, duodenum and jejunum in decreasing order of frequency.
Adult intussusception is a rare disease and symptoms tend to be more chronic or intermittent with vague abdominal pain, nausea and vomiting, abdominal distension with partial obstruction, or palpable abdominal mass at physical examination.
CT - Target like or sausage like mass, the inner central area represents the invaginated intussusceptum surrounded by its mesenteric fat and associated vasculature, all of which are surrounded by the thick-walled intussuscipiens.If blood supply is compromised there is thickening of bowel loops.
Ultrasonography- Multilayered appearance consisting of the alternating hyperechoic and hypoechoic concentric rings that represent alternating layers of mucosa, bowel wall, and mesenteric fat in cross section.
- 1. Ross GJ, Amilineni V. Case 26: Jejunojejunal intussusception secondary to a lipoma. Radiology. 2000;216:727–30. 2. Ouadii Mouaqit, Hafid Hasnai, Leila Chbani et al. Adult intussusceptions caused by a lipoma in the jejunum: World Journal of Emergency Surgery 2012, 7:28