Coloanal intussusception in adults due to lipoma / Intussuscepção colo-anal decorrente de lipoma em adulto

ABSTRACT Adult intussusception is a rare condition. But coloanal intussusception is an exception. Malignant lesions are the most common cause of colonic intussusception, and in this aspect, differ from childhood intussusception. We present a case wherein the patient had a lipoma of the sigmoid colon that caused an immense prolapse through the anus. Very few cases of coloanal intussusception are reported in adults, and we discuss the diagnostic tools and the management of this rare surgical entity.

RESUMO A intussuscepção no adulto é uma entidade rara. Mas a intussuscepção colo-anal é uma exceção. Lesões malignas são a causa mais comum de intussuscepção colônica e, neste aspecto, difere da intussuscepção infantil. Apresentamos um caso de lipoma do cólon sigmoide que causou um prolapso imenso através do ânus. Muito poucos casos de intussuscepção colo-anal foram relatados em adultos e discutimos as ferramentas diagnósticas e o tratamento dessa entidade cirúrgica rara.

Lipomas múltiples en colon. A propósito de un caso / MULTIPLE LIPOMAS COLON. REPORT OF A CASE

Los lipomas del colon son neoplasias benignas subepiteliales,poco frecuentes en este órgano, solo un 10% se presenta como lesiones múltiples y su localización predominante es el colon derecho. Su prevalencia es similar tanto en hombre y en mujeres, suelen ser lesiones asintomáticas y son diagnosticadas incidentalmente; ocasionalmente cuando son mayores de 2 cm la sintomatología es dolor abdominal, obstrucción intestinal, rectorragia o alteración del hábito evacuatorio. Se presenta el caso de paciente femenino de 78 años quien inicia enfermedad actual 12 meses previos a la consulta, presentando cambio de hábito evacuatorio caracterizado por estreñimiento, dolor abdominal difuso tipo cólico, y pérdida de peso no cuantificada asociada a hiporexia. Exámenes de laboratorio reportaron: hemoglobina 10.9 g/dl, hematocrito 38.6% (VCM: 72), leucocitos 9.600 ml/mm3, eosinófilos 21% (eosinofilia moderada), coproanálisis sin alteraciones. Debido a la eosinofilia se le solicita serología para toxocariasis resultando positiva. Endoscopia digestiva superior: hernia hiatal tipo I y gastropatía eritematosa antral, Biopsia: gastritis crónica no atrófica. Endoscopia digestiva inferior: se observan 5 lesiones elevadas entre 3 y 5 cms de diámetro, redondeadas, péndulas, cubierta con mucosa de aspecto normal, de color amarillo, con signo del “cojín”presente, distribuidas en colon transverso, descendente y sigmoides sugestivas de lipoma, además diverticulosis en sigmoides. Se indicó tratamiento con laxante osmótico y antiparasitario presentando mejoría de los síntomas. Actualmente la paciente presenta hemoglobina en 12g/dl, eosinófilos 3% y normalización de la frecuencia evacuatoria y remisión del dolor abdominal.

Colonic lipomas are rare benign neoplasms; approximately 10% present as multiple lesions. The prevalence is equal in both men and women, presenting usually as asymptomatic lesions, which are diagnosed incidentally. However, when they are large (> 2cm) they may present with abdominal pain, intestinal obstruction, rectal bleeding or altered bowel habits. We report on a 78 years old female patient with a 12 months history of changing bowel habits characterized by constipation, diffuse colic abdominal pain, and weight loss associated with hiporexia. Her laboratory tests report eosinophilia: 21% of 9600/mm3 WBC, hemoglobin 10.9 g/dl, hematocrit 38.6%, stool tests were normal. Serology for toxocariasis was positive. Upper gastrointestinal endoscopy revealed hiatal hernia and erythematous gastric mucosa; biopsy was compatible with chronic atrophic gastritis. Colonoscopy revealed 5 raised lesions between 3 and 5cm in diameter, round, pendulous, covered with normal-appearing yellowish mucosa, ("pad sign"). This distribution in the transverse, descending and sigmoid colon is suggestive of lipomas coexisting with sigmoid diverticulosis. Treatment was indicated: osmotic laxative and anti-parasitic medications with symptomatic improvement. Currently the patient has 12g/dl of hemoglobin, and 3% eosinophils with normalization of her bowel movements.