Clin Endosc.  2013 Jul;46(4):414-417.

Endoscopic Treatment of a Symptomatic Ileal Lipoma with Recurrent Ileocolic Intussusceptions by Using Cap-Assisted Colonoscopy

• Lee ES
• Lee KN
• Choi KS
• Lee HL
• Jun DW
• Lee OY
• Yoon BC
• Choi HS

Abstract

A 73-year-old woman presented with intermittent abdominal pain and weight loss of 15 kg for 2 years. Colonoscopy revealed an erythematous polypoid tumor with a long and wide stalk in the cecum, but with air inflation, it abruptly went away through the ileocecal valve (ICV). An abdominal computed tomography showed a well-demarcated pedunculated subepithelial mass of 2.6x2.7 cm size with fat attenuation in the terminal ileum. It was an intussusceptum of the ileal lipoma through the ICV. This ileal lipoma was causing her symptoms because repeated ileocolic intussusceptions resulted in intermittent intestinal obstructions. In order to avoid surgical sequelae of ileal resection, snare polypectomy using cap-assisted colonoscopy technique was performed within the ileum without complications. The histopathology report confirmed it as a subepithelial lipoma. After endoscopic resection of the ileal lipoma, the patient has been free of symptoms and was restored to the original weight.

Keyword

Lipoma; Intussusception; Ileum; Endoscopic treatment; Cap-assisted colonoscopy

MeSH Terms

Abdominal Pain
Cecum
Colonoscopy
Female
Humans
Ileocecal Valve
Ileum
Inflation, Economic
Intestinal Obstruction
Intussusception
Lipoma
SNARE Proteins
Weight Loss
SNARE Proteins

Figure

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  Fig. 1 (A) Colonoscopy showing an ileal lipoma with ileocolic intussusceptions through the ileocecal valve. (B) After air inflation, the ileal lipoma has reverted back to its original site in the ileum and the ileal mucosae have multiple hemorrhagic spots due to having been intussuscepted.

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  Fig. 2 (A) Abdominal computed tomography, showing a well-demarcated lipoma of 2.6×2.7 cm in size with a short peduncle in the terminal ileum. (B) Coronal section.

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  Fig. 3 (A) Submucosal injection of a mixture of saline and epinephrine into the peduncle of the ileal mass. (B) Snare polypectomy was performed by cap-assisted colonoscopy technique. (C) Hemoclipping at the base of the resected portion of the ileum to prevent delayed hemorrhage and perforation.

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