Intussusception implies that an intestinal segment and its mesentery are incorporated within the lumen of the nearby intestinal loop. The former is called an intussusceptum, while the latter is called an intussusceptien. Most cases of Intussusception occur in the first decade of life, especially the first year, in which more than 50% of the reported cases of Intussusception occur. Causes of Intussusception vary according to the age; in pediatric age group, the most frequent cause of Intussusception is lymphoid hyperplasia in the ileo-cecal region [1], while in older children and adults, the cause of Intussusception is usually as a result of a pedunculated intraluminal small intestinal tumor as carcinoma, lymphoma, gastro-intestinal stromal tumor (GIST), or rarely lipoma [2, 3].
Lipoma is a benign mesenchymal tumor formed of benign lipocytes. Lipoma virtually occur in any site of the body [4]. Gastrointestinal lipoma is a rare entity. Most cases of Gastrointestinal lipoma occur in large intestine, followed by small intestine [5]. Small sized Gastrointestinal lipomas are usually asymptomatic, while those which are ≥ 2cm in diameter usually present clinically by Gastrointestinal bleeding, iron-deficiency anaemia, intussusception or bowel obstruction [6]. Herein, we reported a 71-year-old lady who was admitted to the Surgery Department, Sohag University Hospital as she suffered from severe, diffuse colicky abdominal pain and vomiting. Clinical examination and sonography highly suspected a case of intussusception. Exploratory laparotomy was done and relief of intussusception was performed. There was a soft intraluminal small intestinal polyp. Resection anastomosis of the small intestinal loop which harbored the polyp was done. The specimen was sent to the Pathology Department to detect the nature of that polyp.
A 71-year-old woman admitted to Surgery Department, Sohag University Hospital because of sever colicky abdominal pain, nusea and vomiting. The patient mentioned that she was suffering from intermittent colicky abdominal pain and constipation in the last three weeks.
Physical examination revealed a tender mass in the right lower quadrant of the abdomen. Abdominal ultrasound revealed pseudokidney sign. From previous clinical and radiological findings, intussusception was suspected.
The patient underwent exploratory laparotomy.
There was an ileo-colic intussusception. Relief of the intussusception was achieved by gentle milking of the intussusceptum from distal to proximal direction. After reduction, there was an intraluminal soft mass, located about 20 cm proximal to ileo-cecal junction. Resection anastomosis of the involved segment of the small intestine was performed. The specimen was sent to Pathology Laboratory, Sohag University, for histopathological evaluation. The patient recovered and she was discharged 6 days after the operation.
The specimen was opened longitudinally, it revealed a pedunculated polyp with intact overlying mucosa. The polyp was 4.5x 2cm. cut section of the polyp was solid, homogenous yellow and greasy (Figure 1).
Microscopic examination of the polyp revealed small intestinal mucosa and sub mucosa. The mucosa is formed of villi and crypts lined by a single layer of tall columnar and goblet cells. the lamina propria is edematous and showed marked congested blood vessels. The submucosa showed a capsulated mass formed of mature lipocytes, arranged in lobules which are separated by fibrous septa (Figure 2).
The diagnosis of small intestinal submucosal lipoma was assigned.