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[page 8]                                                         [Emergency Care Journal 2015; 11:4884]

A rare case of intussusception
diagnosed by ultrasonography:
lipoma of the colon
Bahjat Barakat,1 Raffaele Pezzilli2

1Department of Emergency, S. Orsola-
Malpighi University Hospital, Bologna;
2Department of Digestive System 
S. Orsola-Malpighi University Hospital,
Bologna, Italy

An 85 year-old female patient was admitted
to the Emergency Room because of persistent
non-specific abdominal pain of 10 days dura-
tion associated to nausea and sometimes vom-
iting. On admission on Emergency Room, the
abdomen was enlarged, without signs of
ascites, and pain on palpation midway between

umbilicus and right inferior quadrant; patient
had no rebound tenderness in all abdominal.
Laboratory examination revealed an increase
of white blood cells (13,500 mmc): renal,
hepatic and coagulation parameters were
within the normal limits. A bed ultrasound
(US) examination showed an imaging compat-
ible with colic intussusception; in fact, a
hypoechoic layer of edematous bowel wall with
echogenic layers (bull’s-eye signs) was detect-
ed (Figure 1). To better define the US picture,
a computed tomography scan was carried out,
showing an inhomogeneous soft tissue mass
containing low and high-density structures,
producing a layered pattern sausage-shaped
(Figure 2). The patient was operated and dur-
ing the operation were found signs of invagi-
nation of the wall (Figure 3). A left colic resec-
tion was carried out and termino-terminal
anastomosis was made. The pathological
examination of the resected specimen showed
the presence of a small lipoma of the colic wall
(Figure 4). Intussusception, as a cause of
intestinal obstruction in adult, is rare entity
and it requires early diagnosis and surgical intervention.1-3 Contrary to the management of

intussusception in children –about 80% of
whom is treated effectively by pneumatic or
hydrostatic reduction, in adults treatment is
mainly surgical.4,5 It should be underlined that
the treatment of adult intussusception is not
universally agreed upon and all authors sug-
gest that laparotomy is mandatory in order to
identify the pathological lesion causing it.3-5 In
our case a lipoma was found on the pathologi-
cal specimen. It is also noticeable how ultra-
sound imaging is a useful first-line approach
for the diagnosis of intussusception in adults. 

References

1. Azar T, Berger DL. Adult intussusception.
Ann Surg 1997;226:134-8. 

2. Khan MN, Agrawal A, Strauss P. Ileocolic
intussusception. A rare cause of acute
intestinal obstruction in adults. Case
report and literature review. World J
Emerg Surg 2008;3:26.

3. Ongom PA, Opio CK, Kijjambu SC.
Presentation, aetiology and treatment of
adult intussusception in a tertiary Sub-
Saharan hospital: a 10-year retrospective
study. BMC Gastroenterol 2014; 14:86.

4. Begos DG, Sandor A, Modlin IM. The diag-
nosis and management of adult intussus-
ception. Am J Surg 1997;173:88-94.

5. Reijnen HAM, DeBoer HHM. Diagnosis
and treatment of adult intussusception.
Am J Surg 1989;158:25-8.

                             Emergency Care Journal 2015; volume 11:4884

Correspondence: Raffaele Pezzilli, Department of
Digestive System, S. Orsola-Malpighi University
Hospital, via Massarenti 9, 40138 Bologna, Italy.
Tel. +39.051.2144148 - Fax: +39.051.2144148.
E-mail: raffaele.pezzilli@aosp.bo.it

Conflict of interest: the authors declare no poten-
tial conflict of interest.

Key words: adult intussusception, sub-acute
symptoms, chronic symptoms, lipoma, resection.

Received for publication: 5 December 2014.
Accepted for publication: 3 February 2015.

This work is licensed under a Creative Commons
Attribution 3.0 License (by-nc 3.0).

©Copyright B. Barakat and R. Pezzilli et al., 2015
Licensee PAGEPress, Italy
Emergency Care Journal 2015; 11:4884
doi:10.4081/ecj.2015.4884

Figure 1. Transverse ultrasonographic
image of the intussusception. Note the
hypoechoic layer of edematous bowel wall
with echogenic layers, known as the bull’s-
eye or target signs.

Figure 2. Contrast-enhanced longitudinal
computed tomography scan showing inho-
mogeneous soft tissue mass containing low
and high-density structures and producing
a layered pattern sausage-shaped.

Figure 3. Surgical specimen showing signs
of invagination of the wall, which conse-
quently has become tortuous and malacic.

Figure 4. Pathological examination of the
resected specimen showing the presence of
a small lipoma of the colic wall.

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