Intussusception Essay

Intussusception describes a condition in which one segment of the intestine (the intussusceptum) telescopes or invaginates into the lumen of an adjacent segment of intestine (the intussuscipiens). The most common neoplasms that cause adult intussusception are adenocarcinoma, lymphomas, GIST, metastatic melanoma, and rarely lipomas [6] Several possible mechanisms have been proposed to explain secondary intussusception ; one of them is the tumor acts as a foreign body causing violent peristalsis leading to invagination of the central part of the bowel into the dilated distal part[6]. In our case, we noticed that the mobility of the cecum and a portion of the ascending colon had an important role in the intussusception formation as they were able
[12] found 37 cases of colonic lipoma causing intussusception after reviewing the English language publications, and we found only four cases of ileocolic intussusception caused by submucosal cecal lipoma and no similar cases of subserosal cecal lipoma causing intussusception after reviewing the English literature using PubMed
The typical radiological features of colonic lipoma are spherical or ovoid homogenous mass with low absorption densities of 40 to 120 Hounsfield units. However, intussuscepted lipomas may have a heterogeneous appearance reflecting the degree of infarction and fat necrosis [5,17,19].
Colonoscopy may play a role in the diagnosis of colonic lipoma and there are some endoscopic features that have been described as “tenting sign” : the mucosa over the lipoma can be pulled up, tenting away from it, and “cushion sign” in which the mass becomes flattened and then restores its shape again like a sponge when compressed.[20]
Colonic lipoma can be resected by means of either endoscopy or surgery. Endoscopic polypectomy is recommended for small lipomas (<2 cm), whereas colonic lipomas exceeding 2 cm should be surgically removed [12,18].
Surgical options include segmental resection, colostomy with local excision, hemicolectomy, or subtotal colectomy according to the size, location of the tumor, and presence of definite preoperative diagnosis [13].