An Unusual Togetherness: Ileo-ileal Intussusception Due to an Ileal Lipoma and Acute Appendicitis

Abstract

Abdominal pain is one of the most common reason of emergency admission in hospitals and acute abdomen is a surgical emergency condition that needs complex diagnosis and treatment. A physician must be careful at differantial diagnosis of appendicitis as a reason of acute abdomen. Intussusception is the invagination of a proximal segment and mesentery of intestine into distal part of bowel. Intussusception can result in acute abdomen due to obstruction and is mostly seen in children aged. Adult intussusception accounts only 5-10 % of all case and is frequently caused by benign or malign tumors Gastrointestinal lipomas were reported as benign lesions in 1757 by Bauer. Lipomas mostly originate from adipocyte cells of the submucosa and subserosa of the intestinal wall. Lipomas smaller than 2 cm frequently have no symptoms but larger than 2 cm diameter mostly have pain, bleeding and obstruction symptoms. Abdominal CT is the most sensitive technique for detecting of presence and level of intussusception. Treatment of adult intussusception is mostly surgery. Laparoscopic surgery is an useful and succesful procedure for small intestine intussesception except cases that have contraindications for laparoscopy This is a case presentation that shows togetherness of intussusception due to ileal lipoma with acute appendicitis.

Keywords

• ileal lipoma
• intussusception
• appendicitis

Nadir Bir Birliktelik: İleal Lipoma Bağlı İntususepsiyon ve Akut Apandisit

Abstract

Karın ağrısı hastanelerdeki acile başvuruların en sık nedenlerinden biri olup, akut batın kompleks tetkik ve tedavi gerektiren bir cerrahi acildir. Hekim akut batının bir nedeni olan apandisitin ayırıcı tanısında dikkatli olmalıdır. Intususepsiyon barsağın ve mezenterinin proksimal kısmının distalinin içine girmesidir. Intusepsiyon çoğunlukla çocukluk çağında görülür ve tıkanıklığa bağlı akut batın nedeni olabilir. Erişkin intusepsiyonu tüm vakların sadece %5-10’ unu oluşturup çoğunluklar benign veya malign tümörlere bağlı oluşur. Gastrointestinal lipomlar 1757’ de Bauer tarafından benign lezyonlar olarak tanımlandı. Lipomlar çoğunlukla barsak duvarının submukoza veya subserozasındaki adiposit hücrelerinden kaynaklanır. 2 cm ‘ den küçük lipomlar genellikler semptom vermezken , 2 cm ‘ den büyükler ağrı, kanama veya tıkanıklığa neden olabilir. Batın BT intusepsiyonun tanısı ve seviyesini tespit etmek için en duyarlı yöntemdir. Erişkin intuepsiyon tedavisi çoğunlukla cerrahidir. Laparoskopik cerrahi kontrendikasyon oluşturmadıkça ince barsak intusepsiyonunda kullanışlı ve başarılı tekniktir. Bu olgu sunumunda; ileal lipoma baağlı intusepsiyon ve akut apandisit birlikteliği olan bir hastayu sunduk.

Keywords

• ileal lipom
• intusepsiyon
• apandisit

References

1. References 1. Liu CD, McFadden DW. Acute abdomen and appendix. Surgery: scientific principles and practice, 1997, 2: 1246-1261.
2. 2. Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician. 1999 Nov 1;60(7):2027-2034.
3. 3. Humes DJ, Simpson J Acute appendicitis. BMJ. 2006 Sep 9;333(7567):530-534
4. 4. Namikawa T, Hokimoto N, Okabayashi T, Kumon M, Kobayashi M, Hanazaki K. Adult ileoileal intussusception induced by an ileal lipoma diagnosed preoperatively: report of a case and review of the literature. Surg Today. 2012 Jul;42(7):686-692
5. 5. Stubenbord WT, Thorbjarnarson B Intussusception in adults. Ann Surg. 1970 Aug;172(2):306-310.
6. 6. Meshikhes AW, Al-Momen SA, Al Talaq FT, Al-Jaroof AH. Adult intussusception caused by a lipoma in the small bowel: report of a case. Surg Today. 2005;35(2):161-165.
7. 7. Dultz LA, Ullery BW, Sun HH, Huston TL, Eachempati SR, Barie PS, Shou J. Ileocecal valve lipoma with refractory hemorrhage. JSLS. 2009 Jan-Mar;13(1):80-83.
8. 8. Buckley JA, Fishman EK. CT evaluation of small bowel neoplasms: spectrum of disease. Radiographics. 1998 Mar-Apr;18(2):379-392.

9. 9. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and Pitfalls in the Emergency Department Evaluation of Abdominal Pain. Emerg Med Clin North Am. 2003;21:61–72
10. 10. T Azar and D L Berger Adult intussusception. Ann Surg. 1997 Aug; 226(2): 134–138.
11. 11. Yao T, Yao K, Matake H, Furukawa K, Nagae T, Motomura A, et al . Primary small intestinal tumors (in Japanese with Englishabstract). Stomach Intestine 2001;36:871–881.
12. 12. Tsushimi T, Matsui N, Kurazumi H, Takemoto Y, Oka K, Seyama A, & Morita T. Laparoscopic resection of an ileal lipoma: report of a case. Surgery today, 2006, 36.11: 1007-1011.
13. 13. Granado de la Fuente A, Granado JM, Ochoa P, Granell J. Lipoma de ciego. Cirugía Espa˜nola 1976;30(2):145–152.
14. 14. Balamoun H, Doughan S. Ileal lipoma – a rare cause of ileocolic intussusception in adults: case report and literature review. World J Gastrointest Surg. 2011 January 27; 3(1): 13–15.
15. 15. Namikawa T, Hokimoto N, Okabayashi T, Kumon M, Kobayashi M & Hanazaki K. Adult ileoileal intussusception induced by an ileal lipoma diagnosed preoperatively: report of a case and review of the literature. Surgery today, 2012, 42.7: 686-692.
16. 16. Bravo AMM, Mansilla CV, Fraguas FN & Vicent, FJG. Ileocolic intussusception due to giant ileal lipoma: Review of literature and report of a case. Int J Surg Case Rep. 2012; 3(8): 382–384.
17. 17. Eisen LK, Cunningham JD, Aufses AH. Intussusception in adults: institutional review. J Am Coll Surg. 1999;188:390–395.
18. 18. Begos DG, Sandor A, Modlin IM. The diagnosis and management of adult intussusception. T Am J Surg. 1997, 173.2: 88-94.
19. 19. Akagi I, Miyashita M, Hashimoto M, Makino H, Nomura T, & Tajiri T. Adult intussusception caused by an intestinal lipoma: report of a case. Journal of Nippon Medical School, 2008, 75.3: 166-170.
20. 20. Reijnen HA, Joosten HJ, de Boer H.H. Diagnosis and treatment of adult intussusception. Am J Surg 1989, 158.1: 25-28.
21. 21. Chekan EG, Westcott C, Low VH, Ludwig KA. Small bowel intussusception and laparoscopy. Surg Laparosc Endosc 1998;8:324–326.