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

Öz

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.

Anahtar Kelimeler

• ileal lipoma
• intussusception
• appendicitis

Nadir Bir Birliktelik: İleal Lipoma Bağlı İntususepsiyon ve Akut Apandisit

Öz

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.

Anahtar Kelimeler

• ileal lipom
• intusepsiyon
• apandisit

Kaynakça

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