Yvette Farran, MS, Jorge A Miranda, MS, Benjamin Clapp, MD, Elizabeth De la Rosa, MD. Texas Tech University Health Sciences Center
Introduction: Sigmoid colon intussusception is rarely encountered and given its vague symptomatology diagnosis and management can be difficult. The treatment of an intussusception in adults is different than in children. Lipomas as the causative etiology for intussusception are encountered up to 0.83% of the times and up to 70%- 90% of the patients require surgical resection for treatment.
Methods: This is a case report about a 62 year old male that presented with two weeks of worsening abdominal pain and distention. Physical exam was only pertinent for abdominal pain on light palpation, guarding and moderate distress. CT scan of abdomen and pelvis demonstrated a lipomatous mass causing complete obstruction of the sigmoid colon with intussusception. This was managed with laparoscopic sigmoidectomy. The patient had an uncomplicated post-operative period and was discharged on post-operative day 2. Pathology of the lipomatous mass confirmed a benign lipoma.
Discussion: Intussusception is rarely encountered in clinical practice in adults and constitutes 5% of all cases. Lipoma induced sigmoid intussusception with complete obstruction is rare. Symptoms can be non-specific as in this case. This case report highlights the importance of timely diagnosis and treatment of an intussusception in adult patients. CT scan is the gold standard for diagnosis and often shows a “target sign”. Other imaging techniques like ultrasound have shown adequate results but remain less effective than CT scan. The treatment in adults is not a reduction by enema like in pediatrics but rather resection of the lead point. This can be appropriately done with a laparoscopic technique in most cases.
Conclusion: Colonic intussusception is rare. Surgery is the only treatment for an intussusception in adults since the lead point needs to be removed, and can be attempted safely with a laparoscopic approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85092
Program Number: P177
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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