Ongom Peter A, Wabinga Henry, Lukande Robert L
Department of Surgery, Colorectal Surgery Unit, School of Medicine, Makerere College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
J Med Case Rep. 2012 Oct 29;6:370. doi: 10.1186/1752-1947-6-370.
Intussusception is an uncommon cause of intestinal obstruction in adults. It usually presents with typical features of intestinal obstruction, and is associated with the presence of a 'lead point' for the invaginated portion. This 'lead point' is rarely an intraluminal, submucosal lipoma.
We describe the case of a 64-year-old African-Ugandan woman of Bantu ethnicity who presented with features of intestinal obstruction secondary to intussusception. She was treated operatively. A left colocolonic invagination was found with the interssusceptum having a giant polyp. A left hemicolectomy was performed. A histopathological examination revealed a polypoid, submucosal lipoma.
In resource-rich countries, most cases of colonic intraluminal polyps are detected through colonoscopy during routine medical check-ups. With limited resources in our region, many tumors present as intestinal obstructions secondary to intussusception. Even then, most are associated with adenomas and malignancies. Rarely are polypoid, submucosal lipomas found. In our patient's case a polyp of 9.5cm at its widest dimension is of particular interest. A lesson to learn is that the differential diagnosis for intussusceptions in resource-poor countries should be broadened to include submucosal lipomas.
肠套叠是成人肠梗阻的罕见病因。它通常表现为肠梗阻的典型特征，并与套入部分的“引导点”有关。这种“引导点”很少是腔内黏膜下脂肪瘤。
我们描述了一名64岁的非洲乌干达班图族女性病例，她因肠套叠出现肠梗阻症状。她接受了手术治疗。发现左半结肠套叠，套入部有一个巨大息肉。进行了左半结肠切除术。组织病理学检查显示为息肉样黏膜下脂肪瘤。
在资源丰富的国家，大多数结肠腔内息肉病例是在常规体检期间通过结肠镜检查发现的。由于我们地区资源有限，许多肿瘤表现为肠套叠继发的肠梗阻。即便如此，大多数与腺瘤和恶性肿瘤有关。很少发现息肉样黏膜下脂肪瘤。在我们患者的病例中，最大直径达9.5厘米的息肉尤其值得关注。需要吸取的教训是，资源匮乏国家肠套叠的鉴别诊断应扩大到包括黏膜下脂肪瘤。
