Giant pedunculated colonic lipoma causing colo-colic intussusception in a patient with mechanical ileus

Abstract

A giant colonic lipoma causing colo-colonic intussusception is extremely rare in adults.
A 35-year-old woman visited our emergency room with abdominal pain, abdominal distension, nausea and vomiting.
Physical examination showed a painful distended abdomen. Abdominal computed tomography revealed that there was a
soft-tissue mass with a fat density of approximately 6 cm in diameter in the distal part of the transverse colon. Since
the clinical presentation was that of a mechanical ileus, a laparotomy was performed. An intussusception was detected
in the transvers colon. A soft and mobile mass was palpated in the transverse colon. Therefore, an extended right hemicolectomy with ileo-transversostomy was performed. Pathological examination revealed a giant pedunculated lipoma of 7
cm in diameter with no evidence of malignancy.
Colonic lipomas are the third most common benign pathology seen in the colon. They are more common in women with
a peak incidence between 50 and 60 years of age. The most common site of lipomas in the large bowel is the right
hemicolon. Colonic lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. Colonic lipoma causing colo-colic intussusception is extremely rare in the current literature. Surgical approach remains the treatment of choice for giant colonic lipomas.
A colonic lipoma causing colo-colic intussusception should be considered in the differential diagnosis of mechanical bowel
obstruction. The most important factor for establishing the diagnosis of intussusception caused by a colonic lipoma is
awareness of the possibility, especially in adult patients with abdominal symptoms and episodes of intestinal obstruction.