Laparoscopic Surgery for an Intussusception Caused by a Lipoma in the Ascending Colon
A 52-year-old woman with intermittent right upper-quadrant (RUQ) abdominal pain without hematochezia of one-month duration visited our hospital. She did not complain of other symptoms such as vomiting or nausea, had no relevant medical or surgical history, and denied alcohol consumption and smoking. A physical examination revealed RUQ tenderness, but no rebound tenderness. No abdominal mass was palpated. Laboratory tests showed hemoglobin 12.6 g/dL, hematocrits 37.6%, platelets 339,000/mm3, aspartate aminotransferase 12 IU/L, alanine aminotrasferase 9 IU/L, and total bilirubin 0.43 mg/dL; all other tests were within normal limits. Electrocardiography, chest X-ray, and plain abdominal X-ray findings were nonspecific. The RUQ tenderness caused us to suspect a gall bladder problem. However, abdominal computed tomography (CT) revealed an intact gall bladder and a lesion suspected of being an intussusception with a fatty mass at the hepatic flexure (). In addition, we noted a 4 cm × 5 cm sized intraluminal mass in the ascending colon, which was suspected of being a lipoma (). The doctor that performed the colonoscopy observed an intraluminal lipoma, and the patient was transferred for surgery.\nAfter reviewing the surgical option, we planned for a laparoscopic right hemicolectomy. Under general anesthesia, the patient was placed in the supine position. One port was then placed at the umbilicus (11 mm) for a camera and was used to establish pneumoperitoneum. Additional ports were placed in the left upper and lower quadrant areas for the surgeon. To perform the operative procedure conveniently, we placed two additional ports (right upper and lower quadrant areas) for an assistant. The operating table was then tilted into a slight head-up position with the left side down to easily mobilize the colon at the hepatic flexure. With a harmonic scalpel, the hepatocolic ligament was divided, the ascending colon was then mobilized using an inferior-to-superior approach, and the ileocolic vessels were ligated. Once the entire right colon had been mobilized, it was extracted through the extended camera port site with a wound protector. A right hemicolectomy and side-to-side anastomosis were performed extracorporeally using staplers. The patient recovered without complications, and was discharged 10 days after surgery. The gross finding of the tumor is shown in ; a histological examination proved it to be a lipoma.