Intramucosallipoma Causing Iliocecal Intussusception in a Patient with Cutaneous Lipomas: A Case Report

Case Report

A Case Report. Austin J Surg. 2015; 2(7): 1078.

Intramucosallipoma Causing Iliocecal Intussusception in a Patient with Cutaneous Lipomas: A Case Report

Brook M¹, Licata L² and Lindsey DE²*

¹Deparment of Medicine, University of Ohio State, USA

²Department of Surgery, University of Ohio State, USA

*Corresponding author: David E Lindsey, Department of Surgery, University of Ohio State, Room 634, 395 W. 12th Avenue, Columbus, Ohio, 43210, USA

Received: September 15, 2015; Accepted: December 11, 2015; Published: December 14, 2015


Introduction: Intussusceptions in adults is rare occurrence and benign lesions such as lipomas are an especially rare cause.

Presentation of Case: This is a case of a 32-year-old man with a history of cutaneous lipomas presenting with small bowel obstruction due to intussusception with a lipoma lead point.

Discussion: Close to 50% of bowel lesions causing intussusception in adults are due to malignant disease. The standard treatment for intussusception in adults is resection. Attempted reduction prior to resection can limit the amount of bowel needing to be removed; however seeding of malignancy is a feared complication. A family or personal history of cutaneous and systemic conditions causing benign tumors can help determine whether a benign etiology is likely and reduction can be safely performed.

Conclusion: Clinical clues from history and physical exam can help determine whether a benign etiology is likely and whether resection prior to reduction should be attempted.

Keywords: Llipoma; Intussusception; Bowel obstruction


Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into another. Intussusception in adults is a rare cause of bowel obstruction accounting for approximately 1% of cases [1]. While the majority of causes of intussusception in children are deemed to be idiopathic, in adults 90% of the cases are the result of a pathogenic process [2,3].

The most likely lead points in adults include benign and malignant tumors, inflammatory lesions, post-operative adhesions, and Meckel’s diverticula [3-5].

Lipomas are third most common primary benign tumor of the gastrointestinal tract [6]. A lipoma is a benign soft tissue tumor made of fat. The majority of gastrointestinal lipomas are found within in the colon, and 90% of them are sub mucosal [7]. A lipoma is an uncommon cause of intussusception but because of their intramural location can serve as a lead point.

As intussusception in adults is a fairly rare phenomenon and often has a nonspecific presentation, clinical suspicion must be high for the diagnosis to be made. We report a case of iliocecal intussusception in a patient with a history of cutaneous lipomas.

Presentation of Case

A 32-year-old male with a history of multiple cutaneous lipomas presented to the emergency department with 4 days of worsening abdominal pain, nausea, and vomiting. He had a history of multiple excised lipomas and one biopsied with pathology revealing “fatty tissue.” Family history revealed multiple relatives with lipomas. The patient’s vital signs were within normal limits on admission and initial labs demonstrated a normal WBC and lactate. His exam was significant for a soft, mildly tender abdomen, with pain worst over the epigastrium, with no peritoneal signs. Multiple lipomas were palpable over the abdominal wall and a fecal occult blood test was positive. A CT scan done in the emergency department demonstrated ileocolonic intussusception without focal fluid collections or free air (Figure 1). The patient was initially treated non-operatively with nasogastric tube decompression, bowel rest, and IV fluids. His symptoms progressed to obstipation with bilious effluent from his NG tube. A follow up acute abdominal series was done which demonstrated findings suggestive of small bowel obstruction and he was taken to the operating room. A diagnostic laparoscopy was performed and an attempted laparoscopic reduction of intussusception was unsuccessful. The surgery was then converted to open. The colon was visualized with a non-reducible dark mass apparent inside. An iliocectomy with ileocolonic anastomosis was performed and intraoperative findings demonstrated an ileocecocolic mass lead point with necrotic small bowel trapped in the cecum (Figures 2-4). Pathology revealed benign submucosal lipoma.