Diagnostic Challenges of Adult Ileo-Ileal Intussusception: A Case Report of a Submucosal Lipoma Acting as a Lead Point

• Khaled Alsherif

  Department of General Sur-gery, Benghazi University, Libya

  Author

Adult intussusception is a rare cause of bowel obstruction and is typically associated with an underlying pathological lead point. Small bowel lipomas are uncommon benign tumours that may cause intussusception, often presenting with nonspecific symptoms that delay diagnosis. This case highlights the diagnostic value of contrast-enhanced computed tomography (CT) and the importance of timely surgical management. Case Presentation: A 55-year-old man presented with a 2-day history of intermittent abdominal pain, nausea, vomiting, and abdominal distension. Laboratory investigations revealed leukocytosis (white blood cell count, 16 × 10⁹/L). Plain abdominal radiography demonstrated multiple air–fluid levels suggestive of small bowel obstruction. Contrast-enhanced CT revealed ileo-ileal intussusception with a well-defined intraluminal fat-density mass measuring 10 cm, consistent with a submucosal lipoma serving as the lead point. Exploratory laparotomy confirmed the diagnosis, and segmental small bowel resection with primary end-to-end anastomosis was performed. Histopathological examination confirmed a benign 10-cm submucosal lipoma with no evidence of dysplasia or malignancy. The postoperative course was uneventful. Oral feeding was resumed on postoperative day 4, and the patient was discharged on postoperative day 7. At the 3-month follow-up, he remained asymptomatic, with complete resolution of symptoms and no evidence of recurrence. Adult intussusception remains a diagnostic challenge because of its nonspecific presentation. Contrast-enhanced CT is the imaging modality of choice for identifying both the intussusception and its pathological lead point, facilitating prompt surgical intervention before bowel ischemia develops. Early recognition and appropriate surgical management are essential for achieving favorables outcomes.

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