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A 'Giant' Intraluminal Lipoma Presenting With Intussusception in an Adult: A Case Report

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A 'Giant' Intraluminal Lipoma Presenting With Intussusception in an Adult: A Case Report

Peter A Ongom et al. J Med Case Rep.

Abstract

Introduction: Intussusception is an uncommon cause of intestinal obstruction in adults. It usually presents with typical features of intestinal obstruction, and is associated with the presence of a 'lead point' for the invaginated portion. This 'lead point' is rarely an intraluminal, submucosal lipoma.

Case presentation: We describe the case of a 64-year-old African-Ugandan woman of Bantu ethnicity who presented with features of intestinal obstruction secondary to intussusception. She was treated operatively. A left colocolonic invagination was found with the interssusceptum having a giant polyp. A left hemicolectomy was performed. A histopathological examination revealed a polypoid, submucosal lipoma.

Conclusions: In resource-rich countries, most cases of colonic intraluminal polyps are detected through colonoscopy during routine medical check-ups. With limited resources in our region, many tumors present as intestinal obstructions secondary to intussusception. Even then, most are associated with adenomas and malignancies. Rarely are polypoid, submucosal lipomas found. In our patient's case a polyp of 9.5cm at its widest dimension is of particular interest. A lesson to learn is that the differential diagnosis for intussusceptions in resource-poor countries should be broadened to include submucosal lipomas.

Figures

Figure 1
Figure 1
Intraoperative photograph. The photograph shows the surgeon’s hand partially ‘grasping’ a polypoid, intraluminal mass (arrow) in the region of the transverse colon. This followed reduction of the transverse colon’s invagination into the descending colon. The splenic ligament has been freed.
Figure 2
Figure 2
Photograph showing the lipomatous polyp. This photograph shows the following labeled structures: (A) stalk, (B) hemorrhagic areas, (C) necrotic mucosal areas. Shown is a soft, hemorrhagic, inflamed, and pedunculated polypoid lipoma. It was detached from the transverse colon lumen, into which it ‘dangled’. Actual size (immediately post-operatively) was 9.5×7.2×6.0cm.
Figure 3
Figure 3
Photomicrograph of mucosal and submucosal areas. Hematoxylin and eosin stained section of gut showing necrotic and inflamed mucosa (A). The submucosa contains areas of hemorrhage (B) and mature adipocytes (C) (magnification ×40, objective lens).
Figure 4
Figure 4
Photograph showing relative size of the lipoma. Demonstration of the relative size of the lipoma. Lying alongside it is a dissecting forceps, for the purpose of comparison.

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