Intussusception is the telescoping of a proximal loop of the bowel within a distal loop, resulting in the obliteration of the lumen. Intussusception is commonly seen in children but rarely seen in adulthood and is often secondary to tumors, motility disorders, or inflammatory diseases. Intussusception in adults accounts for approximately 1% of all bowel obstructions.
Colonic lipomas are a rare benign disease of the GI tract with an incidence rate of 0.035% – 4.4%. They are usually asymptomatic and are found incidentally during autopsy, colonoscopy, or surgery, but larger ones (> 2 cm) may cause symptoms like bleeding, constipation, or pain. Herein, we present a rare case of giant colonic lipoma causing colo-colic intussusception in an adult. Surgical (rather than endoscopic) resection is preferred for lipomas >2 cm to avoid complications such as bleeding and perforation. Herein, we present a rare case of giant colonic lipoma causing colo-colic intussusception in an adult that has been managed successfully with endoscopic resection avoiding major surgery.
Clinical Presentation & Diagnostics
- Patient: A 53-year-old male with a history of Diabetes Mellitus II (DM II).
- Symptoms: Acute bloody diarrhea with a stool frequency of 15–20 times per day (small volume) for 2 weeks.
- Clinical Status: Patient was hemodynamically stable without any dehydration.
- Investigations:
- Routine blood investigations were within normal limits.
- Amoebic Serology (IgG) came positive.
- Colonoscopy showed a large pedunculated polypoidal mass with overlying ulcerations (10*5*5 cm) in the descending colon (Fig 1).
- CECT abdomen confirms a large lipomatous polyp arising from the descending colon causing colo-colic intussusception (Fig 2).
- Patient was hemodynamically stable without any symptoms or signs of acute colonic obstruction. Case discussed with Dr. Girish Hirode (Lap Surgeon).
Management & Treatment
Both endoscopic and surgical (Left hemi-colectomy with stoma) treatment plans were explained to the patient’s relatives in detail. After discussing with the surgeon, the patient was taken up for endoscopic management.
During colonoscopy, we encountered intussusception which was successfully reduced endoscopically. The whole tumor was resected piecemeal (3 small pieces ~ 4*4*2 cm) and one large piece of 8*5*4 cm (Fig 3) with the help of a hot polypectomy snare (50 mm size) without any bleeding or colonic perforation.
Post-Operative Course & Outcomes
- The patient was allowed a soft diet after 4 hours and a full diet from the next day.
- Histopathology confirms the diagnosis of Lipoma (Fig 4).
- The patient is passing formed yellow stool once a day without any bleed and was discharged from the hospital after 48 hours of observation.
