Left Sided Colonic Lipoma Causing Intussusception - A Rare Case Report With Review of Literature

Background: Intussusception is a frequent cause of bowel obstruction in children but is rare in adults. In about 90% of cases, adult intussusception has identifiable cause acting as the lead point. A lipoma may develop as a benign tumor in any organ but rarely in large or small intestines. Intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity. We present a case of intussusception due to a lipoma in the sigmoid colon that was surgically resected. Case report: Elderly female of 76 years presented to emergency department with the complaint of something coming out of rectum and bleeding per rectum for 5 days. She also complained of abdominal fullness and not passing stool for 2 days. Rectal examination revealed a mass protruding from rectum on straining along with blood stained mucus and a patulous anal sphincter. Colonoscopy was not performed in view of clinical features of sub-acute intestinal obstruction. Contrast Enhanced Computed Tomography (CECT) of the abdomen revealed rectosigmoid intussusception. On exploration, bowel appeared congested, edematous and unhealthy. A soft rounded mass was found at the tip of the intussusceptum. Segmental resection of the rectosigmoid junction was performed and bowel continuity was achieved with primary anastomosis. A defunctioning loop colostomy was fashioned to protect the anastomosis. Biopsy of the specimen revealed hemorrhagic infarction of the affected colon with a submucosal lipoma of the sigmoid colon 2.5 x 2 x 1.5 cms in size. Conclusion: Intussusception in adults is rare and usually caused by organic lesions. Abdominal CT is a sensitive, non-invasive method for diagnosis. A colonic lipoma as the principal point for intussusception even though not common can predispose to colonic intussusception.