Scientific letter
Ileocolic intussusception of ileal lipoma as a cause of lower gastrointestinal bleeding
Intususcepción íleo-cólica de lipoma ileal como causa de hemorragia digestiva baja
Eduardo Valdivielso Cortázar
, María López Álvarez, Alberto Guerrero Montañes, Loreto Yañez González-Dopeso, Jesus Ángel Yañez López, Pedro Antonio Alonso Aguirre
Corresponding author
Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Antonio Alonso Aguirre" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Eduardo" "apellidos" => "Valdivielso Cortázar" "email" => array:1 [ 0 => "eduardovaldi@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María" "apellidos" => "López Álvarez" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Guerrero Montañes" ] 3 => array:2 [ "nombre" => "Loreto" "apellidos" => "Yañez González-Dopeso" ] 4 => array:2 [ "nombre" => "Jesus Ángel" "apellidos" => "Yañez López" ] 5 => array:2 [ "nombre" => "Pedro Antonio" "apellidos" => "Alonso Aguirre" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Intususcepción íleo-cólica de lipoma ileal como causa de hemorragia digestiva baja" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 990 "Ancho" => 990 "Tamanyo" => 111225 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ileocolic intussusception of ileal lipoma: tomographic image.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Here we report the case of a 54-year-old man, with no history of interest, who was admitted to hospital for lower gastrointestinal bleeding, manifested as rectal bleeding with dark blood, which did not affect his hemodynamic stability. In the days before admission, he had abdominal pain with cramps, nausea and vomiting. Because of the characteristics of the feces, a gastroscopy was performed, which showed no abnormalities. When performing a colonoscopy, traces of blood were found throughout the colon, as well as a bulging ileocecal valve. An ileoscopy was performed with some difficulty, without being able to see any damage; but when the endoscope was removed again, a whitish lesion was seen in the base of the caecum, which appeared to be ulcerated, but with no active bleeding, and was about 3<span class="elsevierStyleHsp" style=""></span>cm and prolapsed through the ileocecal valve (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Biopsies were taken of the lesion, and it was compatible with a lipoma. The study was completed with a CT scan (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which showed a fat and pedunculated mass, originating on the inner lip of the ileocecal valve, that was prolapsed in the base of the caecum. The patient was assessed in the general surgery department, and it was decided to treat the lesion by using elective laparoscopic right hemicolectomy, which confirmed the origin of the lesion. The surgical specimen measured a total of 18<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm, with a pedicled lesion originating in the terminal ileum and with a maximum size of 5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.3<span class="elsevierStyleHsp" style=""></span>cm, and was brown-colored with macroscopic involvement of the mucosa, compatible with lipoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Lipomas are benign, and usually submucosal, mesenchymal tumors. Gastrointestinal lipomas are located primarily in the right colon, and to a lesser extent, in the small intestine.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> They are usually asymptomatic, and when they do cause symptoms, they are non-specific ones, such as occlusive problems, bleeding, abdominal pain, nausea or diarrhea.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Types of intussusception were classified in 1956 as enteric, colocolic, ileocecal and ileocolic,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> with the most common being enteric intussusception, because it occurs in 43% of patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Our case involves an ileocolic intussusception, with an ileal lipoma being the main cause. Generally, in submucosal lesions such as lipomas, conventional biopsies are not the best means for an accurate diagnosis. In our case this was not so, because the lipoma affected the mucosa macroscopically, which allowed us to collect adipose tissue with a conventional biopsy, thus facilitating the diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Historically the treatment of symptomatic lipomas has been surgical, as in our case, by the use of a laparoscopic right hemicolectomy. In the past few years, cases of single-port laparoscopy have been reported, with fewer complications and a more acceptable esthetic result.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently, endoscopic techniques have been developed to treat lipomas in certain cases, mostly in patients who are not candidates for surgery or who reject it.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Endoscopic submucosal dissection is a technique originally intended for superficial neoplastic lesions, but it has also been used to resect symptomatic lipomas.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> However, this is a complex technique that is not performed at all centers in our setting, and it has a higher rate of complications, mainly perforation and bleeding.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">loop-and-let-go</span> technique consists of placing a disposable loop on the lipoma pedicle, which promotes a slow mechanical resection, thereby reducing the risk of bleeding and perforation.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">unroofing</span> technique consists of the spontaneous removal of the lipoma from the exposed mucosa after making an incision in the upper half of the mucosal surface of the submucosal mass.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">According to the literature, these techniques are mostly used for lipomas located in the colon, whereas in our case the lipoma was located in the terminal ileum, which made the endoscopic approach even more difficult. This being said, cases of ileal lipoma resections have been reported after bringing it into the colonic lumen by aspiration<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> or by placing a cap at the tip of the endoscope.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Despite advances in endoscopic techniques, surgical treatment is of vital importance for sessile lipomas with a wide base of implantation, for cases where diagnosis is uncertain, for lipomas that cause intussusception or obstruction, and for cases of involvement of the serous layers.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valdivielso Cortázar E, López Álvarez M, Guerrero Montañes A, Yañez González-Dopeso L, Yañez López JÁ, Alonso Aguirre PA. Intususcepción íleo-cólica de lipoma ileal como causa de hemorragia digestiva baja. Gastroenterol Hepatol. 2017;40:457–458.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 773 "Ancho" => 985 "Tamanyo" => 115673 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ileocolic intussusception of ileal lipoma: endoscopic view.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 990 "Ancho" => 990 "Tamanyo" => 111225 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ileocolic intussusception of ileal lipoma: tomographic image.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obscure gastrointestinal bleeding caused by small bowel lipoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.W. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 12 | 0 | 12 |
| 2024 September | 31 | 10 | 41 |
| 2024 August | 27 | 11 | 38 |
| 2024 July | 23 | 3 | 26 |
| 2024 June | 13 | 0 | 13 |
| 2024 May | 9 | 4 | 13 |
| 2024 April | 15 | 3 | 18 |
| 2024 March | 17 | 0 | 17 |
| 2024 February | 27 | 1 | 28 |
| 2024 January | 33 | 2 | 35 |
| 2023 December | 30 | 5 | 35 |
| 2023 November | 18 | 4 | 22 |
| 2023 October | 53 | 7 | 60 |
| 2023 September | 29 | 1 | 30 |
| 2023 August | 33 | 2 | 35 |
| 2023 July | 55 | 12 | 67 |
| 2023 June | 36 | 2 | 38 |
| 2023 May | 62 | 1 | 63 |
| 2023 April | 38 | 3 | 41 |
| 2023 March | 54 | 2 | 56 |
| 2023 February | 58 | 3 | 61 |
| 2023 January | 42 | 12 | 54 |
| 2022 December | 34 | 11 | 45 |
| 2022 November | 36 | 6 | 42 |
| 2022 October | 34 | 10 | 44 |
| 2022 September | 44 | 14 | 58 |
| 2022 August | 47 | 7 | 54 |
| 2022 July | 30 | 7 | 37 |
| 2022 June | 23 | 12 | 35 |
| 2022 May | 14 | 9 | 23 |
| 2022 April | 30 | 8 | 38 |
| 2022 March | 35 | 6 | 41 |
| 2022 February | 40 | 4 | 44 |
| 2022 January | 38 | 15 | 53 |
| 2021 December | 33 | 9 | 42 |
| 2021 November | 13 | 7 | 20 |
| 2021 October | 19 | 10 | 29 |
| 2021 September | 29 | 10 | 39 |
| 2021 August | 9 | 8 | 17 |
| 2021 July | 14 | 6 | 20 |
| 2021 June | 11 | 14 | 25 |
| 2021 May | 21 | 5 | 26 |
| 2021 April | 24 | 11 | 35 |
| 2021 March | 12 | 6 | 18 |
| 2021 February | 14 | 6 | 20 |
| 2021 January | 20 | 13 | 33 |
| 2020 December | 14 | 6 | 20 |
| 2020 November | 23 | 4 | 27 |
| 2020 October | 11 | 2 | 13 |
| 2020 September | 13 | 5 | 18 |
| 2020 August | 26 | 10 | 36 |
| 2020 July | 19 | 12 | 31 |
| 2020 June | 14 | 5 | 19 |
| 2020 May | 14 | 7 | 21 |
| 2020 April | 8 | 3 | 11 |
| 2020 March | 7 | 4 | 11 |
| 2020 February | 11 | 5 | 16 |
| 2020 January | 8 | 6 | 14 |
| 2019 December | 19 | 8 | 27 |
| 2019 November | 6 | 4 | 10 |
| 2019 October | 10 | 8 | 18 |
| 2019 September | 3 | 1 | 4 |
| 2019 August | 6 | 8 | 14 |
| 2018 July | 1 | 0 | 1 |
| 2017 August | 3 | 0 | 3 |
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