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Case Reports
, 2018 (7), rjy152
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Intussusception Secondary to Descending Colon Lipoma Presenting With Simultaneous Acute Appendicitis

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Case Reports

Intussusception Secondary to Descending Colon Lipoma Presenting With Simultaneous Acute Appendicitis

Nozomi Kikuchi et al. J Surg Case Rep.

Abstract

We report a patient with a descending colon lipoma presenting with hematochezia who developed intussusception, which was simultaneously accompanied by acute appendicitis. A 43-year-old man presented with hematochezia. Colonoscopy revealed a submucosal tumor with a reddish surface in the descending colon. A solid mass with fat density value measuring 5 cm in diameter was observed in the descending colon on CT. While awaiting elective resection, the patient developed lower abdominal pain. CT demonstrated antegrade colo-colonic intussusception in the descending colon. Simultaneously, the appendix was inflamed with a high density intraluminal lesion suspected to be a fecalith. The diagnosis of simultaneous intussusception and acute appendicitis was made. Appendectomy and partial resection of the descending colon was performed. Histopathological examination was consistent with descending colon lipoma and acute appendicitis. The mechanism for developing hematochezia and the risk for development of colo-colonic intussusception due to large colon lipoma and acute appendicitis were highlighted.

Figures

Figure 1:
Figure 1:
Findings at colonoscopy: (a) A submucosal tumor with a reddish surface and no active bleeding measuring 5 cm in diameter was observed in the descending colon. (b) The mucosa surrounding the submucosal tumor, especially on the opposite side, had mucosal hematoma formation.
Figure 2:
Figure 2:
CT findings at the time of diagnosis: contrast-enhanced CT of the abdomen at the time of diagnosis revealed a solid mass measuring 5 cm in diameter with fat density in the descending colon (white arrow).
Figure 3:
Figure 3:
CT findings at the time of readmission: CT of the abdomen at readmission (a: axial view, b: coronal view) demonstrated antegrade colo-colonic intussusception with the lipoma in the descending colon as the lead point (white arrow). The appendix was also found to be swollen with a high density mass suspected to be a fecalith in the lumen, with inflammation in surrounding tissues (b, black arrow).
Figure 4:
Figure 4:
Surgical specimen and histopathological examination: (a) Macroscopically, the surgical specimen revealed a lipoma covered by normal colonic mucosa with well-demarcated, bright yellow texture. (b) Histopathological examination indicated mature adipose tissue (HE ×400).

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