Intussusception Induced by Transverse Colon Lipoma in a Young Male Patient—One Case Report

Discussion

Lipoma of the gastrointestinal tract was first described by Bauer et al.^[1] in 1757. Its incidence has been reported to range between 0.2% and 4.4%, and it accounts for 2.6% of all gastrointestinal benign tumors^[2]. The median age of patients at the time of diagnosis ranges from 50 to 69 years. Most colonic lipomas occur in the cecum and ascending colon^[3]. Colonic lipomas generally do not cause symptoms, and only a minority of lipomas can cause symptoms when the lesion is large^[3]. Their most common signs and symptoms include abdominal pain, bleeding per rectum, and alterations in bowel movements^[4]. They may also occur, albeit rarely, with such dramatic presentations as massive hemorrhage, intussusception, or even perforation, for which emergency operation is required. The present case is quite exceptional as it involves a young male patient with a symptomatic lipoma located in the transverse colon that induced intussusception due to its size.

Various clinical and imaging methods have been described for the diagnosis of colonic lipomas. CT is an excellent method for diagnosis based on the characteristic fatty densitometric features of lipomas^[5]. However, a preoperative diagnosis mainly depends on colonoscopy because it can provide direct visualization and pathological examination via biopsy forceps. Typical lipomas appear as smooth, spheroidal, and slightly yellowish polyps of variable size, with or without a pedicle. Nevertheless, diagnosing lesions with an atypical, callous, or ulcerated shape may prove to be difficult. The preoperative and intraoperative diagnoses were both difficult to confirm in our case patient. We believe that postoperative pathological examinations are reliable for a definite diagnosis.

Once the removal of a colonic lipoma is considered necessary, it is generally accepted that lipomas up to 2 cm in diameter should be resected by endoscopic cautery snare and that those larger than 2cm should be removed surgically^[6]. Some scholars agree to local enucleation; removal of colonic lipomas via laparoscopy has also been reported, but this practice is still associated with several problems and thus remains controversial.

Laparoscopic surgery was our first choice for our case patient, but he and his family requested a laparotomy instead for which we found local enucleation unsuitable and thus considered resection of the colon segment. Reduction of the intussusception was also not fitting due to the increased risk of perforation and anastomotic complications of the manipulated friable and edematous bowel tissue involved. In summary, the outcomes of this case suggest that intraoperative pathological examination of frozen tissue specimens is essential to rule out interstitial tumors, and we will use this valuable experience in our future work.