Post written by Akira Teramoto, MD, from the Gastrointestinal Center, Sano Hospital, Kobe, Japan.
Our video presents a case of adult ileocecal intussusception due to a lipoma. The intussusception was endoscopically repositioned, and the lipoma was removed by polypectomy.
Although ileocecal intussusception is not a common disease, we believe that many institutions do experience 1 or 2 similar cases every year. Given that there are several reports of surgically treated cases every year, we presented this video to remind physicians that endoscopic treatment should be considered before sending patients to surgeons.
This video case has 2 main learning points. First, it is important to know that endoscopic reduction is a less-invasive treatment option that can avoid emergency surgery. Especially, elderly patients and patients with high-risk comorbidities may benefit dramatically by reducing risk of anastomotic leakage or by avoiding creation of stoma. On the other hand, endoscopists should confirm that necrosis and acute peritonitis are absent before starting procedure, as gas insufflation will exacerbate these conditions.
Second, polypectomy of an ileal lipoma was feasible in terms of safety and recurrence. As we did not attempt complete resection, the procedure was completed comfortably with minimal risk of perforation. Although it is controversial to attempt incomplete resection for young patients, the follow-up colonoscopy showed clearly that incomplete resection was perfectly acceptable for high-risk patients. There are several reports of endoscopic unroofing, which cuts off the upper half of lipomas and local recurrence is not confirmed although follow-up data is insufficient. In this video, we removed approximately 80% of the lesion. This strategy is presented in Japanese literature in the late 1980s by Okamoto et al; they named the method ‘80% resection method.’ Either method seems feasible, and it is not important to determine precise level of cut line. We recommend simple polypectomy method rather than attempting a high-risk procedure such as endoscopic submucosal resection.
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