Colo-colonic intussusception due to large submucous lipoma: A case report

• Intussusception is rare cause of chronic abdominal pain in adults.
• Colo-colonic intussusceptions caused by large submucous lipoma.
• Adults intusseption is rarely caused by idiopathic condition.
• Main causes are inflammatory diseases, benign or malignant tumors, adhesions and other mechanical conditions impairing peristalsis leading to chronic diarrhea.
• Inflammatory diseases, tumors, adhesions or mechanical conditions may lead to this patology.
• Colonoscopy contributes to diagnosis given that it provides direct visualization and biopsy.

IntroductionIntussusception in adult is rarely caused by idiopathic conditions. Main causes are inflammatory diseases, benign or malignant tumors and motility disorders. As a benign cause, lipomas appear as a particularly rare gastrointestinal intraluminal tumor occurring with highest incidence in the colon, mostly in the caecum and ascending colon.Presentation of caseA 57-year-old male patient was admitted at the surgical emergency in Belo Horizonte, with history of chronic and intermittent diffuse abdominal pain, associated with variations of his bowel habits and rare episodes of vomiting starting around 3 days prior to admission.DiscussionIntussusception is the cause of adult symptomatic bowel obstruction in 1% of the cases and its colocolonic occurrence represents 17% of all intestinal intussusceptions in adults. The reported case presents itself as even rarer considering its evaluation according to the epidemiological statistics of 1:5 men/women ratio and lipoma’s most common location being the right colon. Intussusception and intestinal obstructions caused by intraluminal lipomas are not often described in the literature and its occurrence is directly related to its size, usually larger than 2 cm diameter. The management of lipomatous intraluminal lesions of the colon is traditionally surgical, and it allows a selective resection, depending on the size of the tumor, length of intussusception, and the amount of inflammation.ConclusionPatients with chronic abdominal symptoms and semi-obstruction caused by intussusception are rarely diagnosed before surgery unless there is a high index of suspicion. Colonoscopy contributes to diagnosis given that it provides direct visualization and biopsy.