Dr Ridhima

Dr. (Mrs.) Neelu Gupta

Dr. (Mrs.) Sharda Dawan

Dr. (Mrs.) Vanita Kumar

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IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)  
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 16, Issue 3 Ver. IX (March. 2017), PP 77-79 
www.iosrjournals.org 
DOI: 10.9790/0853-1603097779                                         www.iosrjournals.org                                     77 | Page 
 
A Giant Sumucosal Lipoma of Large Intestine Presenting With 
Intussusception in An Adult: A Case Report. 
 
Dr. Ridhima
1
,Dr. (Mrs.) Sharda Dawan
2
, Dr. (Mrs.) Vanita Kumar
3
, 
Dr. (Mrs.) Neelu Gupta
4
 
1,2,3,4
(Department Of Pathology, Sardar Patel Medical College& A.G. Hospitals, Bikaner/ Rajasthan University Of 
Health Sciences, India) 
 
Abstract: Introduction: Colon lipomas are rare. They are almost always asymptomatic; only when their 
diameter is more than 3 cm do they become symptomatic. They tend to occur in an older population and most of 
the cases are located at the right side of the large bowel. Usually the diagnosis is not made until operation is 
performed. Intussusception is an uncommon cause of intestinal obstruction in adults.  
Case presentation: We describe the case of a 52-year-old  female who presented with features of intestinal 
obstruction secondary to intussusception. A colocolonic invagination was found with giant intraluminal lipoma 
on CECT abdomen. She was treated operatively .Exploratory Laprotomy with Segmental  resection  of colon 
wih colocolonic anastamosis was performed. A histopathological examination revealed a polypoid, submucosal 
lipoma. 
Conclusion: In resource-rich countries, most cases of colonic intraluminal polyps are detected through 
colonoscopy during routine medical check-ups. With limited resources in our region, many tumors present as 
intestinal obstructions secondary to intussusception. Even then, most are associated with adenomas and 
malignancies. Rarely are polypoid, submucosal lipomas found. In our patient’s case a polyp of  4.6cm at its 
widest dimension is of particular interest.  
Keywords: Colocolonic, giant polyp, intestinal obstruction, intraluminal, intussusception, lipoma, submucosal 
 
I. Introduction 
Lipoma of the gastrointestinal tract is a rare benign condition described for the first time in 1757 by 
Baurer and reported in only 0.2%–4.4% of large autopsy series since 1955
[1]
.The symptomatic patients with 
lipomas present with abdominal pain, haemorrhage, diarrhoea, or constipation 
[2]
. Lipomas that grow more than 
4 cm in size can lead to obstruction and intussusception. More commonly, definitive diagnosis is made by 
histopathological  staining after the removal of lipoma 
[3]
. Surgical resection is recommended to alleviate 
symptoms and to rule out malignancy 
[3]
.Intussusception was first described by Barbette of Amsterdam in 1674 
[4]
. It is relatively frequent in children but rare in adults, representing 5% of all bowel intussusceptions and 1% 
of all bowel obstruction. Colonic intussusception  is even rarer, above all when caused by lipomas: thirty-seven 
definite cases have been reported in the English-language literature over the past 45 years 
[6]
.In this case report, 
we describe an intussuscepted, colonic lipoma that caused intermittent bowel obstruction. 
 
II. Case Report 
A 52-year-old female was admitted to the general surgery department of our hospital for left-sided 
abdominalpain since 15 days. Her pain was a dull abdominal ache of insidious onset located mainly in the left 
hypochondrium and lumbar region ; the pain was persistent and was not related to food intake. Associated with 
this was diffuse abdominal bloating and flatulence with pellet-like stool motions. Her appetite was good and she 
felt she had neithergained nor lost weight. There was no history of dyspeptic symptoms or vomiting or 
hematochezia during that time, nor had she felt any swelling in her abdomen.     One day prior to admission, she 
developed mucoid, bloody stool motions, but had no frank diarrhea or distinctively foul-smelling stool. She was 
also unable to pass flatus. No history of chronic disease was reported; specifically, diabetes mellitus and 
hypertension The patient was admitted to the hospital and CECT scan of abdomen revealed bowel obstruction 
with colocolonic intussusception with an intraluminal lipoma. The patient underwent an exploratory laparotomy.  
A Segmental  resection  of colon was performed followed by colocolonic anastomosis and the 
specimen was sent for histopathological examination.Here in pathology department we received a specimen of 
intestine measuring 10x7x4 cm.On cutting, a pedunculated polypoidal mass  was seen in lumen which measured 
4.6x4x2.6 cm (Fig. 1). The cut surface of mass was glistening yellow and mucosa was lost in the region where it 
was attached. The microscopic examination confirmed the mass as submucosal lipoma(Fig. 2,3). 
 
A Giant Sumucosal Lipoma Of Large Intestine Presenting With Intussusception ….. 
DOI: 10.9790/0853-1603097779                                         www.iosrjournals.org                                     78 | Page 
.       
Figure1.Gross examination revealed                  Figure 2. Microscopic examination of large 
glistening yellow polypoidal mass Submucosal lipoma (H&E, x10) 
 
 
Figure 3. Submucosal lipoma (H&E, x40). benign adipocytes in Submucosa with sparing of mucosa 
 
III. DISCUSSION 
Lipomas occur throughout the intestinal tract with the colon having the highest incidence. They constitute the 
most frequent benign tumor of the colon and rectum after adenomas. Nevertheless they are uncommon.
[7]
. 
Colonic lipomas are more common in women with a peak incidence between 50 and 60 years of age 
[8,9]
.They 
are mostly located in the right colon: 19% in cecum, 38% in ascending colon, 22% in transverse colon, 13% in 
the descending colon, and 8% into the sigmoid colon. The most frequent type is the submucosal lipoma with a 
sessile or pedunculated appearance, and the remainderare subserosal lipomas. They are almost always 
asymptomatic; only when their diameter is more than 3 cm do they become symptomatic. Their clinical 
symptoms are directly related to their size. The common symptoms of colonic lipomas include changes in 
intestinal rhythm, rectorrhagia, diarrhea, abdominal pain, occupation of the colonic lumen by the mass, or 
intestinal intussusception caused by the progression of the pedunculated lipoma
[10]
. After intussusception 
abdominal pain is associated with vomiting, palpable mass and bloody stool, presenting for 
many days or even weeks Lipomas can also present in the form of multiple polyps in the colon. Some may 
exhipit atypical stromal cells and mimic malignancy. Considering the age and symptoms of these patients, 
malignant tumors are also a matter of concern
 [11]
. For the diagnosis, colonoscopy allows direct visualization
 
of 
the submucosal lipoma, which appears as a mass covered
 
by normal mucosa, but it can also show ulcerated or 
necrotic
 
overlying mucosa
[6,12,13]
.Colonoscopic biopsy confirms
 
the nature, but inadequate tissue samples often 
indicate
 
nonspecific colitis with mucosal inflammation
 
In case of intussusception, abdominal CT scanning is the radiologic modality of choice, above all when 
giant lipomas are present, with a 70–80% sensitivity and near 100% specificity
[5,15]
. Lipoma appears with fat-
equivalent density, near ovoidal shape, and smooth margins.However, intussuscepted lipomas may have a 
heterogeneous appearance reflecting the degree of infarction and fat necrosis
[5,16]
. 
There are different options for treatment. Small lipomas, less than 2 cm, can be endoscopically 
removed. Since lipomas show no malignant degeneration, if the biopsy is unequivocal, they may not need 
A Giant Sumucosal Lipoma Of Large Intestine Presenting With Intussusception ….. 
DOI: 10.9790/0853-1603097779                                         www.iosrjournals.org                                     79 | Page 
treatment and can be observed.Some authors have reported that large pedunculated lesions can be removed 
without perforation using clipping or endoloop ligation
[15]
, but in most series endoscopic removal of lipomas 
larger than 2cm is associated with a greater risk of perforation 
[6, 15]
. It is therefore recommended that tumors 
larger than 2 cm must be resected surgically Moreover, the size of the lipoma is an essential factor leading to 
colonic intussusception, particularly when mainaxis of the lesion is over 4 cm. This is the reason why colonic 
lipomas of 4 cm or more must be resected before intussusception occurs
[6]
. If a colonic lipoma is diagnosed 
before surgery, segmental resection is an adequate treatment. Since the majority of colonic intussusceptions are 
caused by primary adenocarcinoma, in view of the uncertain etiology, nondiagnosed lipoma before operation 
must be interpreted as for cancer, and a more or less extensive resection of the colon is recommended, 
depending on the location of the tumor. Patients must undergo more or less extensive resection of the colon also 
depending on the length of the intussusception segment
[6,17] 
 
IV. Conclusion 
Lipomas of digestive tract are rare and often  asymptomatic and  with their unusual properties, present 
Difficulties in pre-operative differentiation between malignant and benign colonic neoplasms. Furthermore, the 
investigative procedures are challenging; this is particularly the case in resource-limited areas.. Also, Colonic 
obstruction due to intussusception caused by lipomas is a very rare condition that needs urgent treatment. CT is 
the radiologic modality of choice for diagnosis (sensitivity 80%, specificity near 100%); since the majority of 
colonic intussusceptions are caused by primary adenocarcinoma, if the etiology is uncertain, the lesion must be 
interpreted as malignant and extensive resection is recommended. At present, surgery is the treatment of choice 
and determines an excellent outcome. 
 
References 
[1]. E. Grasso and T. Guastella, “Giant submucosal lipoma cause colo-colonic intussusception. A case report and review of literature,” 
Annali Italiani di Chirurgia, 83(6) , 2012,  559– 562. 
[2]. Ghidirim G, Mishin I, Gutsu E et al. Giant submucosal  lipoma of the cecum: report of a case and review of  literature. Romanian 
Journal of Gastroenterology; 14(4) 2005,  393-6. 
[3]. Bardaji M, Roset F, Camps R, Sant F, Fernandez-Layos MJ. Symptomatic colonic lipoma: differential diagnosis of  large bowel 
tumors. International Journal of Colorectal Disease; 13(1), 1998 : 1-2 
[4]. A. S. Krasniqi, A. R. Hamza, L. M. Salihu et al., “Compound double ileoileal and ileocecocolic intussusception caused by lipoma of 
the ileum in an adult patient. A case report,” Journal of Medical Case Reports, 5, 2011, 452. 
[5]. O. Mouaqit, H. Hasnai, L. Chbani et al., “Pedunculated lipoma causing colo-colonic intussusception: a rare case report,” BMC 
Surgery,       13( 1), 2013, 51. 
[6]. S. Paˇskauskas, T. Latkauskas, G. Valeikaite et al., “Colonic intussusception caused by colonic lipoma: a case report,” Medicina, 
46( 7),  2010, 477–481. 
[7]. Marra B: Intestinal occlusion due to a colonic lipoma. A report of 2 cases. Minerva Chir Sep 30; 48(18): 1993, 1035-9  
[8]. R. A. De Beer and H. Shinya, “Colonic lipomas: an endoscopic analysis,” Gastrointestinal Endoscopy, 22( 2), 1975, 90–91. 
[9]. B. A. Taylor and B. G. Wolff, “Colonic lipomas - Report of two unusual cases and review of the mayo clinic experience, 1976- 
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[10]. Cirino E, Cali V, Basile G, Muscari C, Caragliano P, Petino A: Intestinal invagination caused by colonic lipoma. Minerva Chir Sep; 
51(9): 1996, 717-23  
[11]. Ryan J, Martin JE, Pollock DJ: Fatty tumours of the large intestine: A clinicopathological review of 13 cases. Br J Surg 76: 1989, 
793-796.  
[12]. M. Michowitz, N. Lazebnik, S. Noy, and R. Lazebnik, “Lipoma of the colon. A report of 22 cases,” American Surgeon, 51( 8), 
1985, 449–454,. 
[13]. P. C. Buetow, J. L. Buck, N. J. Carr, L. Pantongrag-Brown, P. R. Ros, and D. F. Cruess, “Intussuscepted colonic lipomas: loss of fat 
attenuation on CT with pathologic correlation in 10 cases,” Abdominal Imaging, 21(2), 1996, 153–156. 
[14]. P. Katsinelos, G. Chatzimavroudis, C. Zavos, G. Paroutoglou, B. Papaziogas, and J. Kountouras, “A novel technique for the 
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467–469. 
[15]. G. S. Raju and G. Gomez, “Endoloop ligation of a large colonic lipoma: a novel technique,” Gastrointestinal Endoscopy, 62(6), , 
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[16]. S.Tamura, Y. Yokoyama,T.Morita, T. Tadokoro,Y.Higashidani, and S. Onishi, “„Giant‟ colon lipoma: what kind of findings are 
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A Giant Sumucosal Lipoma of Large Intestine Presenting With Intussusception in An Adult: A Case Report

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A Giant Sumucosal Lipoma of Large Intestine Presenting With Intussusception in An Adult: A Case Report

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