An obese 42-year-old woman presented to the emergency department complaining of intermittent abdominal cramping for 4 weeks. She felt the cramping in the left upper quadrant of her abdomen. For 7 days prior to presentation, the patient had increasing pain in this region accompanied by the passage of multiple unformed stools. She experienced neither melena nor hematochezia. Her appetite waned during the 3 days prior to presentation. Her past medical history was significant only for a cesarean section many years before. Physical examination was remarkable only for decreased bowel sounds and moderate tenderness in the mid-abdomen. There were no palpable masses and her stool tested negative for occult blood.
Computed tomography of the abdomen revealed a large, round mass leading an intussusception in the transverse colon (Figure 1). The attenuation coefficient of the mass suggested that it was composed of fat. The diagnosis of a giant colonic lipoma was made.
Figure 1. Computed tomography of the abdomen reveals a large, round mass in the transverse colon. This appears to be the leading edge of an intussusception. The attenuation coefficient of the mass (-60 Houndsfield units) suggests that it is composed of adipose tissue.
Colonoscopy was performed in an attempt to reduce the intussusception and resect the lipoma endoscopically. A very large, round, yellow mass was seen in the transverse colon (Figure 2).
Figure 2. Endoscopic appearance of a 5-cm colonic lipoma. This was the leading edge of a colo-colonic intussusception.
Attempts to snare the lesion were unsuccessful and the patient subsequently underwent a curative partial colectomy. Pathology was confirmatory.
Medscape Gastroenterology. 2002;4(1) © 2002 Medscape
Cite this: Colo-colonic Intussusception Due to a Giant Colonic Lipoma - Medscape - Feb 13, 2002.