Case Report
An ileo-ileal intussusception secondary to polypoid lipoma in a child, a case report and review of the literature

https://doi.org/10.1016/j.ijscr.2019.03.003Get rights and content
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Highlights

  • Small intestinal lipoma is a rare reason for ileoileal intussusception but should be included in the differential diagnosis for lead points causing intussusception in children.

  • Dexamethasone as an adjuvant treatment may improve the outcome in cases of intussusceptions but this point needs future researches.

  • Intermittent attacks of small intestinal intussusception may lead to dilation of the distal segment (Intussuscipiens). This mechanism may delay vascular compromise.

  • High level of clinical suspicion needs to diagnose intussusception with unusual presentation.

Abstract

Background

Intramuscular intestinal lipoma is one of the rare benign tumours of the small intestine in children and acts as a lead point of intussusception.

Presentation of case

We describe a case in which a 4-year-old boy presented with recurrent attacks of colicky abdominal pain and non-bilious vomiting. Abdominal examination was irrelevant. Per rectum (PR) examination indicated an empty rectum without red currant jelly stool and non-palpable mass. Abdominal ultrasonography revealed a target sign of intussusception. After a period of conservative treatment, the child passed normal coloured and well-formed stool. Exploratory laparotomy referred to a long segment ileo-ileal intussusception with a polypoid lipoma as a lead point. Microscopic examination showed a benign non-capsulated intramuscular ileal lipoma.

Discussion

Small bowel lipoma produces symptoms of intermittent bowel obstruction. Herein, the child presented with non- bilious vomiting, we attribute this to reflex sympathetic stimulation of the pylorus leading to pylorospasm.

Conclusion

Small intestinal lipoma is a rare finding in children that may cause intussusception which does not resolve spontaneously.

Keywords

Small intestinal intussusception
Small intestinal lipoma
Unusual presentation of intussusception
Intramuscular lipoma

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