Submucosal lipoma acting as a leading point for colo-colic intussusception in an adult
A 49-year-old gentleman presented to our emergency department with a 10-day history of intermittent abdominal pain. The pain was exacerbated by eating and he reported a reduced appetite. His past medical history included a right-sided nephrectomy for a benign tumour and an appendicectomy.\nOn examination, he was apyrexial and vital signs were all within normal limits. Abdominal examination revealed a soft abdomen, with localized epigastric tenderness. There were no palpable masses and bowel sounds were normal. Laboratory blood tests were unremarkable, apart from a mild microcytic anaemia.\nAbdominal ultrasound demonstrated a bowel-related mass lesion in the epigastric region (Fig. ). Computed tomography (CT) scan of the abdomen and pelvis revealed a 3 × 6 cm fatty ovoid lesion within the transverse colon resulting in intussusception (Fig. ). Colonoscopy showed an abnormal dusky grey lesion occupying most of the lumen in the distal transverse colon. There were two ulcerated areas on the front of the lesion, most likely the leading point of the intussusception. A laparotomy was performed. Intussusception of the transverse colon was found, for which an extended right hemicolectomy was performed (Fig. ), with ileo-transverse colon anastomosis and defunctioning loop ileostomy. The patient had an uneventful postoperative recovery and returned later for reversal of his loop ileostomy. The histopathology report confirmed a 6 × 4.5 cm submucosal lipoma acting as a leading point for the intussusception. There was no evidence of malignancy.