P2330 - Colonic Intussusception: A Rare Syndrome Treated With a Novel Therapeutic Modality

Abdul Aziz Siddiqui, MD¹, Kazi Khan, MD², Mohammad Aasim Khan, MBBS³, Mohammed Qadeer, MD^4
1Aurora Healthcare, Milwaukee, WI; ²Saint Luke's Hospital, Milwaukee, WI; ³Khyber Medical College & Advocate Health Aurora St. Luke’s Medical Center, Milwaukee, WI; ⁴Aurora Healthcare, Kenosha, WI

Introduction: Large bowel obstruction accounts for approximately 25% of all intestinal obstructions, of which less than 5% are secondary to intussusception. Intussusception can be further characterized by etiology, location and direction of telescoping. Colonic lipomas are benign, relatively common incidental findings on endoscopy, and are rarely symptomatic

Case Description/Methods: A 43 year old male with a history of asthma, sleep apnea and alcoholic pancreatitis presents to the emergency room with 4 days of progressively worsening colicky epigastric pain. He denied constipation, diarrhea, obstipation, nausea, vomiting, or hematochezia. Examination revealed normal vital signs and mild abdominal distension with tenderness. Labs revealed mild leukocytosis. CT scan revealed a 6 cm lesion - likely lipoma arising from the hepatic flexure and causing intussusception of the transverse colon with partial small and large bowel obstruction. After discussions with surgery, it was decided to remove the lipoma by endoscopic submucosal dissection (ESD). Colonoscopy revealed significant colonic wall edema and a large lipoma that was successfully resected by ESD. Due to its large size, it was retrieved only after sectioning into multiple pieces. The mucosal defect was approximated by 5 Endoclips. The patient had complete resolution of symptoms after the procedure and was discharged home after overnight observation.

Discussion: Colonic intussusception secondary to a large lipoma is an exceedingly rare condition. In this case, endoscopic submucosal dissection was performed to alleviate mechanical bowel obstruction with great efficacy. ESD represents a great alternative to open surgery insofar as reducing costs to healthcare systems, recovery time, and potential sparing of the intestines by avoiding surgery. Bowel perforation is a feared complication of ESD and can occur in up to 5% of cases; however, this can also be managed endoscopically with clips to approximate the margins of any defect. We believe ESD offers unseen potential as a therapeutic modality as evident in this case, and more literature is required to explore this prospect.



Disclosures:


Abdul Aziz Siddiqui, MD¹, Kazi Khan, MD², Mohammad Aasim Khan, MBBS³, Mohammed Qadeer, MD⁴. P2330 - Colonic Intussusception: A Rare Syndrome Treated With a Novel Therapeutic Modality, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.