Minimally invasive management of colonic lipoma causing intussusception with endoloop in an adult

Intussusception is a condition in which one segment of the intestine (intussusceptum) telescopes into the lumen of an adjacent segment (intussuscipiens), potentially leading to obstruction. Giant colonic lipomas are rare and often asymptomatic, but when large enough, can serve as a lead point for intussusception. We present the case of a 62-year-old male patient who presented with nausea and vomiting. A computed tomography (CT) abdomen/pelvis without contrast showed intussusception of the ascending colon into the transverse colon without bowel obstruction, along with a lobulated fatty mass at the tip of the intussusceptum. This mass was suspected to be a colonic lipoma serving as the lead point. Due to the patient's benign abdominal exam, emergent surgical intervention was deferred. A colonoscopy then revealed a large, 5 cm pedunculated lipoma in the transverse colon near the hepatic flexure. An Endoloop was applied and tightly cinched around the base of the lesion. He was discharged in stable condition with recommendations for close gastroenterology follow-up. The purpose of presenting this case is to highlight the utilization of endoscopy in management of colonic intussusception caused by a structural lesion, as well as the importance of considering intussusception as the cause of a patient's nausea and vomiting (although it is a rare cause in adults). A CT scan is helpful in establishing this diagnosis and guiding management. Furthermore, if intussusception is suspected in an adult, it is important to consider a structural lesion that may be acting as a lead point, such as an intraluminal tumor or mass.