A Case of Colonic Intussusception Caused by Cecal Lymphangioma and Requiring Emergency Surgery.

ABSTRACT

Lymphangiomas are benign tumors of dilated lymphatic vessels often found in the head, neck, and axilla of children. Lymphangiomas rarely occur in the abdomen, much less in the colon of adults. Colonic lymphangioma can cause symptoms and signs such as abdominal pain and abdominal distension and complications of gastrointestinal bleeding and intussusception. Intussusceptions are rarer in adults than in children. Most cases of intussusception in adults have a distinct cause, and a substantial number are related to malignant tumors. Herein, we report a rare case of ileocecal intussusception caused by cecal lymphangioma that required emergency surgery. A 40-year-old woman presented with severe abdominal pain of a two-day duration. Her abdomen was tender and showed muscle rigidity in the right lower quadrant. Contrast-enhanced CT of the abdomen revealed ileocecal intussusception and a cystic mass, which was the leading point, with no evidence of bowel strangulation. The patient underwent emergency laparoscopic surgery because she had severe abdominal pain and showed peritoneal irritation signs. During surgery, the cecum was found to have invaginated into the ascending colon, almost to the hepatic flexure. Laparoscopic ileocecal resection with central vascular ligation was performed without intraoperative reduction of the intussusception because the cystic lesion could have a malignant component. Upon inspection, the lesion was a 60 mm × 50 mm submucosal mass located in the cecum. It was filled with clear serous fluid and thin walls. Pathology revealed the cystic mass to be a cecal lymphangioma with no evidence of malignancy. The patient was discharged seven days after emergency surgery with no complications. Our case adds to evidence that cecal lymphangiomas can cause colonic intussusception in adults. Although rare, the risk of colonic intussusception must be considered in the management of colonic lymphangiomas.