Supplementary Material for: Jejunal Lipoma-Induced Intussusception Mimicking Crohn's Disease: A Case Report

Small bowel intussusception is a rare occurrence in adults and typically indicates an underlying gastrointestinal (GI) pathology, which may include solid masses or chronic inflammatory conditions like Crohn's disease. We present a complex case involving a patient with a history of Crohn’s and GI bleeding, who was found to have a bleeding lipoma serving as a lead point for intussusception.
We present a 70-year-old male with a history of Crohn’s and chronic GI bleeding, necessitating blood transfusions and iron infusions. Labs revealed a hemoglobin of 6.8 g/dL, iron 18 µg/dL, ferritin 13 ng/dL. The patient reported dark stools (guaiac positive), abdominal pain, and fatigue, but denied any hematochezia. Initial endoscopic examinations revealed gastritis but were otherwise inconclusive. Capsule endoscopy identified a bleeding site in the proximal jejunum along with ulcerations in the jejunum and ileum, consistent with Crohn's. The patient was started on mesalamine, which effectively controlled his symptoms but did not resolve his anemia. A double-balloon enteroscopy revealed a 5-cm frond-like villous mass in the jejunum, without active inflammation. Subsequent imaging with computed tomography (CT) and magnetic resonance enterography (MRE) confirmed the presence of a jejunal lipoma, which was acting as a lead point for intussusception. The patient underwent a laparoscopic small bowel resection with jejuno-jejunal anastomosis. The surgery was well tolerated, and his hemoglobin levels have remained stable postoperatively.
In adults, approximately 90% of intussusceptions are attributed to a pathological lead point. In Crohn's, inflammatory infiltrates can form granulomas that act as a lead point. Similarly, solid tumors, such as lipomas, can also serve as lead points. In this patient, the lipoma was initially obscured by the Crohn’s diagnosis, complicating the identification of the intussusception source and subsequent treatment. Given the rarity of symptomatic small bowel lipomas, there is no consensus on their management. However, surgical intervention is generally recommended because it is challenging to rule out malignancy, and management guidelines for colonic lipomas are often applied. This case exemplifies the importance of considering multiple underlying pathologies in patients with complex GI symptoms and highlights the need for a thorough diagnostic approach to guide effective treatment.