Kenji Ikeuchi

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.

Management of Early Colorectal Carcinoma Defined by Endoscopic Findings

Two hundred seventy-one cases (330 lesions) of early colorectal carcinoma were analyzed to assess the primary treatment modality by endoscopic findings. All cases were classified into two groups, namely intramucosal polypoid growth-type (PG-ca; 287 lesions), and nonpolypoid growth-type (NPG-ca; 41 lesions), according to histological findings. Two hundred forty-one lesions of PG-ca were intramucosal carcinomas (m-ca) and 46 were submucosal carcinomas (sm-ca). All 43 lesions of NPG-ca were sm-ca. The incidence of massive invasion to submucosa was greater in NPG-ca (53.8%) than in PG-ca (8.9%). Lymph node metastasis was detected in 5 lesions, (11.6%) of NPG-ca and in 4, (1.4%) of PG-ca. In contrast, over 80% of nodular tumors with depressions defined by colonoscopic findings were NPG-ca and all of the lobular type were PG-ca.