Intussusception is a rare cause of intestinal obstruction in adults and is usually secondary to malignant neoplasms as the pathologic leading point. We present a case of ileocolic intussusception in an adult caused by a large pedunculated cecal lipoma and mobile cecum. The patient was a 45-year-old woman with 3 weeks’ history of colicky abdominal pain, hematochezia, and alternating bowel habits. Computed tomography of the abdomen revealed ileocolic intussusception with 75 cm low-density mass in the cecum. Right hemicolectomy was performed, and histopathological examination of the specimen confirmed the diagnosis of a subserosal cecal lipoma.

1. TITLE LAYOUT
• SUBTITLE
1

2. SUBSEROSAL CECAL LIPOMA : A
RARE CAUSE OF ILEO-COLIC
INTUSSUSCEPTION IN ADULTS
BY
AMR BADAWY 1, AHMED SHAWKY 2, MOHAMED SHARAAN3
1. A.Lecturer , General Surgery Department, Alexandria University, Egypt.
Guest Research Associate , Graduate School Of Medicine, Kyoto University, Japan
2. Professor Of General Surgery, General Surgery Department, Alexandria University, Egypt.
3. Professor Of General Surgery, General Surgery Department, Alexandria University, Egypt

3. HISTORY
• A 45-year-old female patient presented at the
Emergency department with :
• Acute central colicky abdominal pain
• Vomiting,
• Constipation
• A single episode of bleeding per rectum.
3

4. PHYSICAL EXAMINATION
• The abdomen was slightly distended, with mild
tenderness in the right side of the abdomen.
• All Laboratory Investigations Were Normal Except :
• Mild Leucocytosis
• Hypoalbuminemia
• Hypokalemia
4

5. RADIOLOGICAL INVESTIGATIONS
• Abdominal U/S and CT:
• Target sign
• Distal intraluminal mass with fat attenuation
5

6. CT ABDOMEN
6

7. 7

8. Provisional Diagnosis And Management
• Ileo-colic Intussusception.
• ??Colonic Or Ileal Neoplasm.
• ?? Benign Or Malignant Neoplasm
• So Exploratory Laparotomy was
performed
8

9. INTRA-OPERATIVE FINDINGS
• Ileo-colic Intussusception  Partly Reduced.
• Cecal Mass
• Mobile Cecum And Part Of Ascending Colon.
• Frozen-section was not Available.
• Right Hemicolectomy  ?? Malignant Tumor.
• The Surgical Specimen  Pedunculated Cecal
mass about 7 X 5 cm.
9

10. HISTOPATHOLOGICAL DIAGNOSIS
• Subserosal Cecal Lipoma with
evidence of Traumatic Fat Necrosis.
10

11. BIBLIOTHECA ALEXANDRINA
11

12. DISCUSSION
12

13. INTUSSUSCEPTION
• Intussusception describes a condition in which one
segment of the intestine telescopes or invaginates
into the lumen of an adjacent segment of intestine.
• It is
• common in pediatric patients and usually
idiopathic.
• Rare in adults and usually secondary to
malignant neoplasms in up to half of
the cases.(1)
• Most neoplasm-related cases are due to
adenocarcinoma, lymphomas,
gastrointestinal stromal tumors,
metastatic melanomas, and rarely
lipomas.(2) 13
1. Varban O, Ardestani A, Azagury D, et al. Contemporary management of adult intussusception: who needs a resection? World J Surg. 2013;37:1872.
2. Rogers SO, Lee M, Stanley A (2002) Giant colonic lipoma as lead point for intermittent colo-colonic intussusception. Surgery 131:678–680

14. ADULT INTUSSUSCEPTION
• PATHOGENESIS :
 The tumor may act as a foreign body 
provoke abnormal peristaltic movement 
leads to telescoping of one bowel segment 
into the dilated distal part. (1)
 In our case, mobility of the cecum and a
portion of the ascending colon played a key
role in the intussusception formation as they
were able to follow the lead point telescoping
into the distal colon.
14
1. Rogers SO, Lee M, Stanley A (2002) Giant colonic lipoma as lead point for intermittent colo-colonic
intussusception. Surgery 131:678–680

15. COLONIC LIPOMA
• Colonic Lipoma 
• Rare non-epithelial neoplasms
• First described by bauer in 1757 .(1)
• Incidence : 0.2 % to 4.4 %.(2)
• More common in elderly women
• Mainly in the cecum and ascending colon.(3)
• Most of them are small in size, solitary and
asymptomatic. (3)
• 30 % of them reach 2 cm or larger in
diameter -- > may present with anemia,
constipation, bleeding, diarrhea, abdominal
pain or intussusception.(4)
• Only in 10 – 25% of cases are multiple
lesions.(5)
15
1. Ryan J, Martin JE, Pollock DJ. Fatty tumours of the large intestine: a clinicopathological review of 13 cases. Br J Surg, 1989; 76: 793-796.
2. Vecchio R, Ferrara M, Mosca F, Ignoto A, Latteri F. Lipomas of the large bowel . Eur J Surg 1996;162: 915–919.
3. Ladurner R, Mussack T, Hohenbleicher F, Folwaczny C, Siebeck M, Hallfeld K. Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance. Surg Endosc
2003;17:160.
4. Rogy MA, Mirza D, Berlakovich G, Winkelbauer F, Rauhs R. Submucous large-bowel lipomas: presentation and management. An 18-year study. Eur J Surg 1991;157:51-55.
5. Suárez Moreno RM, Hernández Ramírez DA, Madrazo Navarro M, Salazar Lozano CR, Martínez Gen R. Multiple intestinal lipomatosis. Case report. Cir Cir 2010;78:163-165.

16. COLONIC LIPOMA
• Usually arise from the submucosa and appear as sessile
polypoid masses.
• Rarely they arise from the subserosa and /or appear as
pedunculated polypoid masses.(1-2)
• Paskauskas et al. Found 37 cases of colonic lipoma
causing colonic intussusception after reviewing the
english language publications. (3)
• We found only four cases of ileocolic intussusception
caused by submucosal cecal lipoma. (4-7)
• No similar cases of subserosal cecal lipoma causing
ileocolic or colo-colic intussusception after reviewing
the english literature using pubmed .
16
1. Atmatzidis S, Chatzimavroudis G, Patsas A, et al. “Pedunculated cecal lipoma causing colo-colonic intussusception: a rare case report,” Case Reports in Surgery
2012, Article ID 279213.
2. Zhang, Xuchen, Ouyang J, Yong-Doo K. "Large ulcerated cecal lipoma mimicking malignancy." World J Gastrointest Oncol 2.7 (2010): 304-306.
3. Paškauskas, Saulius, et al. "Colonic intussusception caused by colonic lipoma: a case report." Medicina (Kaunas) 46.7 (2010): 477-481.
4. Triantopoulou, C., et al. "Adult ileocolic intussusception secondary to a submucosal cecal lipoma." Abdominal imaging 29.4 (2004): 426-428.
5. Kuzmich, Siarhei, et al. "Ileocolocolic intussusception secondary to a submucosal lipoma: An unusual cause of intermittent abdominal pain in a 62‐year‐old
woman." Journal of Clinical Ultrasound 38.1 (2010): 48-51.
6. Gys, B., Haenen F, Gys T. "Ileocolic Intussusception Caused by a Giant Ulcerating Lipoma of Bauhin’s Valve: an Unusual Cause of Intestinal Obstruction in the
Adult." Indian Journal of Surgery 77.1 (2015): 1-2.

17. DIAGNOSIS
• In Abdominal CT And MRI :
 Colonic lipoma  spherical or ovoid
mass with sharp margins and low
absorption densities (fat densities).(1-2)
 However, intussuscepted lipomas may
have a heterogenous appearance
reflecting the degree of infarction and
fat necrosis present at the time of
radiologic evaluation. (3)
17
1. Rogy MA, Mirza D, Berlakovich G, Winkelbauer F, Rauhs R. Submucous large-bowel lipomas: presentation and management. An 18-year study. Eur J
Surg 1991;157:51-55.
2. Notaro, J. R, Masser PA. "Annular colon lipoma: a case report and review of the literature." Surgery 110.3 (1991): 570-572.
3. Buetow PC, Buck JL, Carr NJ, et al. (1996) Intussuscepted colonic lipomas: loss of fat attenuation on CT with pathologic correlation in 10 cases.

18. DIAGNOSIS
• Colonoscopy  a mass covered by
normal mucosa.
• Some of endoscopic features have
been described including : (1-4)
• Tenting sign the mucosa can be
pulled up, tenting away from the mass
• Cushion sign flattening and
restoration of the shape of lipoma
18
1. De Beer RA, Shinya H. Colonic lipomas. An endoscopic analysis. Gastrointest Endosc 1975;22:90-1.
2. Michowitz M, Lazbuik N, Noy S, Lazbuik R. Lipoma of the colon. A report of 22 cases. Am Surg 1985;51:449-54.
3. Castro E, Stearns M. Lipoma of the large intestine: a review of 45 cases. Dis Colon Rectum 1972;15:441-4.
4. Messer J, Waye JD. The diagnosis of colonic lipomas – the naked fat sign. Gastrointest Endosc 1982;28:186-8.

19. MANAGEMENT
• Colonic lipoma can be resected by
either endoscopy or surgery.
• Endoscopic polypectomy is
recommended for small lipoma (<2
cm). (1)
• While colonic lipoma exceeding 2 cm
should be surgically removed.(2)
191. Jiang L, Jiang LS, Li FY, Ye H, Li N, Cheng NS, Zhou Y. Giant submucosal lipoma located in the descending colon: a case
report and review of the literature. World J Gastroenterol 2007; 13(42): 5664-7.
2. Paškauskas, Saulius, et al. "Colonic intussusception caused by colonic lipoma: a case report." Medicina (Kaunas) 46.7
(2010): 477-481.

20. MANAGEMENT
• Surgical options include
• Segmental resection,
• Colostomy with local excision,
• Hemicolectomy, or
• Subtotal colectomy
• According to the size, location of the
tumor, and presence of definite
preoperative diagnosis.(1)
20
1. Jiang L, Jiang LS, Li FY, Ye H, Li N, Cheng NS, Zhou Y. Giant submucosal lipoma located in the descending colon: a case report
and review of the literature. World J Gastroenterol 2007; 13(42): 5664-7.

21. CONCLUSION
• Intussusception in adults is
• Rare
• Usually caused by malignant
neoplasms,
• However colonic lipoma should be
considered in the differential
diagnosis.
• The high risk of bowel infarction make
intussusception a true surgical
emergency.
21

22. CONCLUSION
• CT abdomen is the investigation of choice in
the diagnosis of intussusception secondary to
colonic lipoma.
• Intraoperative frozen section is important for
doubtful cases of colonic lipoma
• Surgical approach remains the treatment of
choice for large colonic lipoma .
22

23. REFERENCE
• VARBAN O, ARDESTANI A, AZAGURY D, ET AL. CONTEMPORARY MANAGEMENT OF ADULT
INTUSSUSCEPTION: WHO NEEDS A RESECTION? WORLD J SURG. 2013;37:1872.
• GAYER G. INTUSSUSCEPTION: NOT ONLY A CHILDHOOD DISEASE. ISR MED ASSOC J 2001;3:962.
• VECCHIO R, FERRARA M, MOSCA F, IGNOTO A, LATTERI F. LIPOMAS OF THE LARGE BOWEL . EUR J SURG
1996;162: 915–919.
• LADURNER R, MUSSACK T, HOHENBLEICHER F, FOLWACZNY C, SIEBECK M, HALLFELD K. LAPAROSCOPIC-
ASSISTED RESECTION OF GIANT SIGMOID LIPOMA UNDER COLONOSCOPIC GUIDANCE. SURG ENDOSC
2003;17:160.
• ROGY MA, MIRZA D, BERLAKOVICH G, WINKELBAUER F, RAUHS R. SUBMUCOUS LARGE-BOWEL LIPOMAS:
PRESENTATION AND MANAGEMENT. AN 18-YEAR STUDY. EUR J SURG 1991;157:51-55.
• RYAN J, MARTIN JE, POLLOCK DJ. FATTY TUMOURS OF THE LARGE INTESTINE: A CLINICOPATHOLOGICAL
REVIEW OF 13 CASES. BR J SURG, 1989; 76: 793-796.
• BARDAJÍ M, ROSET F, CAMPS R, SANT F, FERNÁNDEZ-LAYOS MJ. SYMPTOMATIC COLONIC LIPOMA:
DIFFERENTIAL DIAGNOSIS OF LARGE BOWEL TUMORS. INT J COLORECTAL DIS 1998;13:1-2.
• ATMATZIDIS S, CHATZIMAVROUDIS G, PATSAS A, ET AL. “PEDUNCULATED CECAL LIPOMA CAUSING COLO-
COLONIC INTUSSUSCEPTION: A RARE CASE REPORT,” CASE REPORTS IN SURGERY 2012, ARTICLE ID 279213.23

24. REFERENCE
• ZHANG, XUCHEN, OUYANG J, YONG-DOO K. "LARGE ULCERATED CECAL LIPOMA MIMICKING MALIGNANCY." WORLD J GASTROINTEST
ONCOL 2.7 (2010): 304-306.
• SUÁREZ MORENO RM, HERNÁNDEZ RAMÍREZ DA, MADRAZO NAVARRO M, SALAZAR LOZANO CR, MARTÍNEZ GEN R. MULTIPLE
INTESTINAL LIPOMATOSIS. CASE REPORT. CIR CIR 2010;78:163-165.
• PAŠKAUSKAS, SAULIUS, ET AL. "COLONIC INTUSSUSCEPTION CAUSED BY COLONIC LIPOMA: A CASE REPORT." MEDICINA (KAUNAS) 46.7
(2010): 477-481.
• NOTARO, J. R, MASSER PA. "ANNULAR COLON LIPOMA: A CASE REPORT AND REVIEW OF THE LITERATURE." SURGERY 110.3 (1991):
570-572.
• JIANG L, JIANG LS, LI FY, YE H, LI N, CHENG NS, ZHOU Y. GIANT SUBMUCOSAL LIPOMA LOCATED IN THE DESCENDING COLON: A CASE
REPORT AND REVIEW OF THE LITERATURE. WORLD J GASTROENTEROL 2007; 13(42): 5664-7.
• TRIANTOPOULOU, C., ET AL. "ADULT ILEOCOLIC INTUSSUSCEPTION SECONDARY TO A SUBMUCOSAL CECAL LIPOMA." ABDOMINAL
IMAGING 29.4 (2004): 426-428.
• KUZMICH, SIARHEI, ET AL. "ILEOCOLOCOLIC INTUSSUSCEPTION SECONDARY TO A SUBMUCOSAL LIPOMA: AN UNUSUAL CAUSE OF
INTERMITTENT ABDOMINAL PAIN IN A 62‐YEAR‐OLD WOMAN." JOURNAL OF CLINICAL ULTRASOUND 38.1 (2010): 48-51.
• GYS, B., HAENEN F, GYS T. "ILEOCOLIC INTUSSUSCEPTION CAUSED BY A GIANT ULCERATING LIPOMA OF BAUHIN’S VALVE: AN UNUSUAL
CAUSE OF INTESTINAL OBSTRUCTION IN THE ADULT." INDIAN JOURNAL OF SURGERY 77.1 (2015): 1-2.
• MCKAY R. "ILIOCECAL INTUSSUSCEPTION IN AN ADULT: THE LAPAROSCOPIC APPROACH." JSLS. 10.2 (2006): 250.
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