Twist-a-pull: Unraveling the Rare Encounter of Colo-Colic Intussusception Caused by Submucosal Lipoma

Abstract

In adults, colo-colic intussusception is mainly associated with colonic malignancies, with CT scans identifying a lead point in 70-90% of cases. Benign causes, like submucosal lipomas, are less common, with incidences between 0.2% and 4.4%. This report describes a rare instance of right-sided colo-colic intussusception caused by a submucosal lipoma in a 72-year-old female. She presented with acute intestinal obstruction, sudden abdominal distension, and localized right lower quadrant pain, worsening over a week. CT imaging revealed ileo-colic intussusception. Intraoperatively, caecum-ascending colon colo-colic intussusception with proximal bowel obstruction was identified. A midline laparotomy, right hemicolectomy, and primary anastomosis were performed, with histopathology confirming a submucosal lipoma without malignancy. The patient had an uneventful recovery.

Submucosal colonic lipomas, typically asymptomatic, can cause intussusception, obstruction, bleeding, and abdominal pain, complicating diagnosis due to their similarity to malignancies. They are most common in the ascending colon/caecum, followed by the sigmoid, descending, and transverse colon, and should be considered in differential diagnoses. Although benign lesion-induced intussusception is rare in adults, accurate diagnosis and timely intervention are crucial to prevent complications. Pre-operative identification is challenging due to non-specific symptoms, but CT scans are invaluable for diagnosis, effectively pinpointing the tumor site as a lead point