Ascending Colon Intussusception caused by Ileal Hemangiolipoma: A Case Report

Ascending Colon Intussusception caused by Ileal Hemangiolipoma: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Ascending Colon Intussusception caused by Ileal Hemangiolipoma: A Case Report Zheng Shu, Zhe Li, Shengnan Lin, Haihua Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7534282/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Angiolipoma, a rare benign intestinal tumor, is primarily diagnosed through abdominal imaging and pathological examination. Intestinal angiolipomas frequently cause intussusception, necessitating prompt surgical resection. Case Presentation: This paper reports a 62-year-old female patient admitted to the First Affiliated Hospital of Shandong First Medical University with "unprovoked paroxysmal abdominal pain for 3 months." Preoperative diagnosis indicated ascending colonic intussusception secondary to ileal angiolipoma. Pathological examination following surgical bowel resection confirmed the lesion as an (ileal) angiolipoma. Conclusions: Given the rarity of this pathological entity in the intestinal tract, we present this case. Angiolipoma intussusception Rare pathological type Case Report Figures Figure 1 Figure 2 INTRODUCTION Hemangiolipoma is a distinct benign adipose tissue tumor [ 1 ] , composed of mature adipocytes and abnormally proliferating blood vessels (predominantly small-caliber). It most commonly occurs in subcutaneous tissues [ 2 ] , particularly the forearms (near the elbow region), trunk (back, shoulders, abdomen), and lower extremities (thighs, calves). Involvement of the breast, paravertebral region, or gastrointestinal tract is exceedingly rare [ 3 – 5 ] .This case report describes a 60-year-old female patient who presented with CT findings suggestive of intussusception involving the ascending colon and ileocecal region. Following endoscopic reduction, the intussusception recurred rapidly, necessitating partial small bowel resection with anastomosis. Serial abdominal computed tomography (CT) imaging demonstrated temporal evolution of the lesion. Histopathological examination of the resected bowel specimen confirmed the rare diagnosis of an ileal angiolipoma. CASE REPORT A 62-year-old woman presented to The First Affiliated Hospital of Shandong First Medical University in February 2025 with a 3-month history of paroxysmal abdominal pain, exacerbated over the preceding 4 days. Her medical history included renal cyst unroofing decortication in 2018, with no family history of cancer. Physical examination revealed mild abdominal distension without visible bowel patterns or peristalsis, abdominal wall tension and resistance, tenderness with rebound tenderness; liver and spleen were non-palpable, Murphy's sign was negative, no costovertebral tenderness was elicited, bowel sounds were slightly hyperactive (6-8/min), and shifting dullness was absent. Pre-admission gastroscopy showed no significant abnormalities. Admission lower abdominal CT demonstrated an irregular structure in the ascending colon with adipose tissue invagination into the lumen, irregular wall thickening, and no enlarged pericolonic lymph nodes (Figure 1A). Following clinical assessment, endoscopic reduction of the intussusception was performed. However, a repeat CT one day post-reduction revealed tortuous bowel loops in the ascending colon and ileocecal region, a double-tube sign in the ascending colon with mesenteric fat herniation, associated wall thickening, and pericolonic fat stranding, suggesting recurrent ascending colonic intussusception (Figure 1B). Given the confirmed diagnosis and prompt recurrence after endoscopic reduction, laparoscopic partial small bowel resection was undertaken. Intraoperatively, after reducing the intussuscepted bowel, a firm mass was identified approximately 15 cm proximal to the ileocecal valve, deemed the cause of the refractory intussusception, and resected for pathology. Postoperative CT showed findings consistent with laparoscopic small bowel resection, including linear high-density opacities and patchy soft tissue densities in the subcutaneous surgical site, with mild wall thickening around the anastomosis (Figure 1C). Pathological examination of the small bowel specimen revealed a submucosal angiolipoma (3.7 x 3.0 x 2.7 cm) with surface ulceration, located in the submucosa compressing the underlying muscularis propria downward, with uninvolved resection margins (Figure 2A, B). Immunohistochemistry was positive for CD34 (vascular component) and negative for HMB-45 and Melan-A. DISCUSSION Lipomas represent the most common benign mesenchymal tumors. They are broadly categorized into simple lipomas, composed solely of mature adipocytes, and fibrolipomas, which contain an admixture of adipose and fibrous tissue [6] . Histologically, they can be further classified as angiolipomas or intramuscular lipomas [7-8] . Within the intestines, angiolipomas predominantly arise in the submucosa or subserosa, with a higher incidence in the small bowel compared to the colon [9] . To evaluate the clinical relevance of lipomas causing intussusception, a literature search was conducted using PubMed (pubmed.ncbi.nlm.nih.gov), the free public database developed by the US National Library of Medicine (NLM). Employing the search strategy ("lipoma" OR "angiolipoma") AND "intussusception" for publications between January 2015 and January 2025, and applying predefined inclusion/exclusion criteria supplemented by manual review of reference lists, 635 articles related to "lipoma" were identified. Of these, 22 specifically addressed "angiolipoma", and only 6 reported cases occurring in the gastrointestinal tract [4, 10-14] . Most gastrointestinal angiolipomas are small (<2 cm) and asymptomatic. However, when tumors exceed 2 cm in size or undergo hemorrhagic rupture, they can precipitate gastrointestinal bleeding, intestinal obstruction, or intussusception [15] . Intussusception occurs precisely because the angiolipomatous mass acts as a "lead point," propelled by peristalsis into the distal bowel lumen [16] . The etiology of intussusception in adults differs fundamentally from that in children. Over 90% of adult cases have an identifiable pathological cause, broadly categorized as neoplastic or non-neoplastic [17] . Non-neoplastic causes account for only 30–40% of cases, including anatomic abnormalities (e.g., Meckel's diverticulum, intestinal adhesions) and inflammatory or infectious processes [18-20] . In contrast, neoplastic factors constitute 60–70% of etiologies, encompassing both malignant tumors (colorectal carcinoma, lymphoma, or metastatic cancer) and benign neoplasms (lipomas, gastrointestinal stromal tumors, or adenomatous polyps) [21-23] . Current management primarily involves surgical intervention. Comprehensive preoperative evaluation typically identifies the underlying cause, including the precise location of intussusception and presence of a pathological "lead point [24] . The initial surgical step involves manual reduction of the intussuscepted bowel segment, followed by assessment for ischemic bowel necrosis and underlying tumor pathology. For benign tumors, surgical resection is generally curative. Reported recurrence rates following resection of benign lead points are less than 5% [9] .Gastrointestinal angiolipomas are exceptionally rare. Dr. Juan Sun et al. aggregated all reported cases over the past two decades, identifying only 30 documented instances. Their analysis revealed that these tumors predominantly affect middle-aged and elderly males, with the ileum and colon being the most common sites. Notably, small bowel involvement exceeds colonic occurrence [9] . Abdominal pain presents non-specifically; however, angiolipomas in the upper gastrointestinal tract typically manifest with hemorrhage, whereas those in the lower tract primarily cause pain and obstruction. Remarkably, during follow-up extending to 10 years post-resection, no recurrences were documented among the 30 patients. The diagnostic challenge lies in the non-specificity of abdominal symptoms, underscoring the critical role of abdominal CT. In the present case, the patient's longstanding gastric history initially directed evaluation toward upper GI pathology, leading to gastroscopy alone. Crucially, abdominal CT was not performed at initial symptom onset. Consequently, surgical intervention was delayed until bowel necrosis developed. While resection was ultimately performed, earlier imaging could have prevented progression to transmural compromise and mitigated risks of hemorrhagic shock or intra-abdominal infection. In summary, ileal angiolipoma represents a rare yet treatable etiology of adult intussusception. In the present case, preoperative CT identification of a fat-density mass with vascular enhancement proved crucial for differentiating this benign lesion from malignancies such as gastrointestinal stromal tumors (GISTs) or lymphoma. Complete surgical resection remains the gold standard for preventing recurrence and complications. Clinicians should include angiolipoma in the differential diagnosis of adults presenting with occult GI pain or unexplained intussusception, particularly when imaging demonstrates fat-containing lesions. The accumulation of additional cases remains necessary to elucidate its pathogenesis and optimize management strategies. Declarations Funding Not applicable. Competing interests Not applicable. Ethics approval Not applicable. Consent to participate Informed consent was obtained from the patient for participation in this case report. Written Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Availability of data and material Data supporting this study's findings are available from the corresponding author upon reasonable request. Code availability Not applicable. Authors' contributions Haihua Yu found this case report. Zheng Shu and Zhe Li wrote the manuscript. Shengnan Lin analyzed the data. All authors have read and approved the final version of the manuscript. References Dupuis H, Lemaitre M, Jannin A, Douillard C, Espiard S, Vantyghem MC. Lipomatoses. Ann Endocrinol (Paris). 2024;85(3):231-247. doi:10.1016/j.ando.2024.05.003. Kransdorf MJ, Larsen BT, Goulding KA, Cumsky JL, Hwang S, Long JR. Angiolipoma: a review of 778 lesions in 344 patients. Skeletal Radiol. 2023;52(3):541-552. doi:10.1007/s00256-022-04075-9. Dilege E, Bozkurt E, Kulle CB, Bulutay P, Agcaoglu O. A rare tumor of the male breast "angiolipoma" Case report and review of literature. Ann Ital Chir. 2022;11:S2239253X22036945. Published 2022 Feb 25. Vara-Luiz F, Nunes G, Oliveira C, et al. Duodenal angiolipoma: a rare tumor causing recurrent upper gastrointestinal bleeding. Rev Esp Enferm Dig. 2023;115(11):674-675. doi:10.17235/reed.2023.9744/2023. Iampreechakul P, Tangviriyapaiboon T, Liengudom A, Lertbutsayanukul P, Thammachantha S, Siriwimonmas S. Sacral Extradural Angiolipoma Associated with Tight Filum Terminale and Spina Bifida Coexisting with Spinal Arteriovenous Fistula. World Neurosurg. 2020;140:37-45. doi:10.1016/j.wneu.2020.04.239. Charifa A, Azmat CE, Badri T. Lipoma Pathology. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 5, 2022. Yee EJ, Stewart CL, Clay MR, McCarter MM. Lipoma and Its Doppelganger: The Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma. Surg Clin North Am. 2022;102(4):637-656. doi:10.1016/j.suc.2022.04.006. Achar S, Yamanaka J, Oberstar J. Soft Tissue Masses: Evaluation and Treatment. Am Fam Physician. 2022;105(6):602-612. Sun J, Kang W, Zeng Z, Zhang Z, Wang X. Rare localization of angiolipoma in the gastrointestinal tract: a case series. J Int Med Res. 2020;48(9):300060520938589. doi:10.1177/0300060520938589. Ni X, Yin J, Chen L, Zhu Z. Endoscopic resection of a rare duodenal polypoid mass: duodenal angiolipoma. Rev Esp Enferm Dig. 2023;115(6):332-333. doi:10.17235/reed.2022.9268/2022. Lou XH, Chen WG, Ning LG, Chen HT, Xu GQ. Multiple gastric angiolipomas: A case report. World J Clin Cases. 2019;7(6):778-784. doi:10.12998/wjcc.v7.i6.778. Alghamdi SA, Alshammery SM, Alamari MS, Alshehri MA, Alshahrani AS. An unusual case of gastric angiolipoma presenting with upper gastrointestinal bleeding. Oxf Med Case Reports. 2022;2022(11):omac119. Published 2022 Nov 24. doi:10.1093/omcr/omac119. Choi JH, Park SB, Lee JB, Lee TJ, Park HJ, Lee ES. A Huge Gastric Angiolipoma Presenting with Acute Upper Gastrointestinal Hemorrhage: A Case Report. Curr Med Imaging. 2023;19(8):945-949. doi:10.2174/1573405618666220822095201. Kimura A, Morinaga N, Tajima K, et al. Colon angiolipoma with intussusception resected by laparoscopy-assisted surgery: a case report. J Surg Case Rep. 2021;2021(8):rjab329. Published 2021 Aug 10. doi:10.1093/jscr/rjab329. Alharbi K, Bilal A. Colonic Angiolipoma: A Rare Cause of Chronic Anemia and Rectal Bleeding. Cureus. 2024;16(3):e56678. Published 2024 Mar 22. doi:10.7759/cureus.56678IF: 1.3 Q2. Nissen A, Yi F. Rare cause of colonic intussusception in an adult. BMJ Case Rep. 2017;2017:bcr2017221976. Published 2017 Sep 15. doi:10.1136/bcr-2017-221976. Neymark M, Abramov R, Dronov M, Gilshtein H. Management of Adult Intussusception-A Case Series Experience from a Tertiary Center. World J Surg. 2021;45(12):3584-3591. doi:10.1007/s00268-021-06277-z. Xia F, Sun Z, Wu JH, Zou Y. Intussusception after reconstruction following gastrectomy for gastric cancer. World J Surg Oncol. 2021;19(1):340. Published 2021 Dec 8. doi:10.1186/s12957-021-02456-3. Huang Q, Peng X, Hu S, Tan X, Li X. Diabetic ketoacidosis complicated with intussusception: a case report. World J Emerg Med. 2024;15(5):419-421. doi:10.5847/wjem.j.1920-8642.2024.084. Chong EH, Kim DJ, Kim S, Kim G, Kim WR. Inverted Meckel's diverticulum: Two case reports and a review of the literature. World J Gastrointest Surg. 2018;10(6):70-74. doi:10.4240/wjgs.v10.i6.70. Yang Y, Jia D, Jiang C. Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception-a case report and literature review. World J Surg Oncol. 2022;20(1):44. Published 2022 Feb 23. doi:10.1186/s12957-022-02519-z. Zhu LB, Li PF, Xiao WH, Zhang PB, Li JQ, Sun MF. A distal ileum malignant peripheral nerve sheath tumor causing intussusception in a patient in China: a case report. World J Surg Oncol. 2017;15(1):29. Published 2017 Jan 19. doi:10.1186/s12957-017-1101-z Panzera F, Di Venere B, Rizzi M, et al. Bowel intussusception in adult: Prevalence, diagnostic tools and therapy. World J Methodol. 2021;11(3):81-87. Published 2021 May 20. doi:10.5662/wjm.v11.i3.81 Patsikas MN, Papazoglou LG, Paraskevas GK. Current Views in the Diagnosis and Treatment of Intestinal Intussusception. Top Companion Anim Med. 2019;37:100360. doi:10.1016/j.tcam.2019.100360 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":216616,"visible":true,"origin":"","legend":"\u003cp\u003eAbdominal CT imaging findings.\u003c/p\u003e\n\u003cp\u003e(A) Pre-endoscopic reduction CT: Axial view showing intussuscepted bowel segment (yellow arrow) in the ascending colon.\u003c/p\u003e\n\u003cp\u003e(B) Post-endoscopic reduction CT (24 hours): Recurrent intussusception (yellow arrow) with mesenteric fat entrapment.\u003c/p\u003e\n\u003cp\u003e(C) Post-laparoscopic resection CT: Surgical site demonstrating bowel at anastomotic site (yellow arrow) with mild wall thickening.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7534282/v1/b13691633f951f437fc36a4b.jpeg"},{"id":92126165,"identity":"c73c5031-b997-482d-8f09-374563468c83","added_by":"auto","created_at":"2025-09-25 01:32:30","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":471864,"visible":true,"origin":"","legend":"\u003cp\u003eHistopathological analysis of the resected bowel segment.\u003c/p\u003e\n\u003cp\u003e(A) Gross specimen demonstrating a well-circumscribed submucosal mass (arrowhead) with surface ulceration.\u003c/p\u003e\n\u003cp\u003e(B) Microscopic view (H\u0026amp;E, 40×) showing submucosal angiolipoma composed of mature adipose tissue (black arrow) and proliferating blood vessels (red arrow).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7534282/v1/72f9e9dd305d35c00bcdfb7b.jpeg"},{"id":92128072,"identity":"58c3bf6d-72a2-4d9e-8bd7-548685b4f5a7","added_by":"auto","created_at":"2025-09-25 02:04:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1010913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7534282/v1/1c01e68b-920a-429b-a1ef-520e1157cf10.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ascending Colon Intussusception caused by Ileal Hemangiolipoma: A Case Report","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHemangiolipoma is a distinct benign adipose tissue tumor\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, composed of mature adipocytes and abnormally proliferating blood vessels (predominantly small-caliber). It most commonly occurs in subcutaneous tissues\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, particularly the forearms (near the elbow region), trunk (back, shoulders, abdomen), and lower extremities (thighs, calves). Involvement of the breast, paravertebral region, or gastrointestinal tract is exceedingly rare\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.This case report describes a 60-year-old female patient who presented with CT findings suggestive of intussusception involving the ascending colon and ileocecal region. Following endoscopic reduction, the intussusception recurred rapidly, necessitating partial small bowel resection with anastomosis. Serial abdominal computed tomography (CT) imaging demonstrated temporal evolution of the lesion. Histopathological examination of the resected bowel specimen confirmed the rare diagnosis of an ileal angiolipoma.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA 62-year-old woman presented to The First Affiliated Hospital of Shandong First Medical University in February 2025 with a 3-month history of paroxysmal abdominal pain, exacerbated over the preceding 4 days. Her medical history included renal cyst unroofing decortication in 2018, with no family history of cancer. Physical examination revealed mild abdominal distension without visible bowel patterns or peristalsis, abdominal wall tension and resistance, tenderness with rebound tenderness; liver and spleen were non-palpable, Murphy\u0026apos;s sign was negative, no costovertebral tenderness was elicited, bowel sounds were slightly hyperactive (6-8/min), and shifting dullness was absent. Pre-admission gastroscopy showed no significant abnormalities. Admission lower abdominal CT demonstrated an irregular structure in the ascending colon with adipose tissue invagination into the lumen, irregular wall thickening, and no enlarged pericolonic lymph nodes (Figure 1A). Following clinical assessment, endoscopic reduction of the intussusception was performed. However, a repeat CT one day post-reduction revealed tortuous bowel loops in the ascending colon and ileocecal region, a double-tube sign in the ascending colon with mesenteric fat herniation, associated wall thickening, and pericolonic fat stranding, suggesting recurrent ascending colonic intussusception (Figure 1B). Given the confirmed diagnosis and prompt recurrence after endoscopic reduction, laparoscopic partial small bowel resection was undertaken. Intraoperatively, after reducing the intussuscepted bowel, a firm mass was identified approximately 15 cm proximal to the ileocecal valve, deemed the cause of the refractory intussusception, and resected for pathology. Postoperative CT showed findings consistent with laparoscopic small bowel resection, including linear high-density opacities and patchy soft tissue densities in the subcutaneous surgical site, with mild wall thickening around the anastomosis (Figure 1C). Pathological examination of the small bowel specimen revealed a submucosal angiolipoma (3.7 x 3.0 x 2.7 cm) with surface ulceration, located in the submucosa compressing the underlying muscularis propria downward, with uninvolved resection margins (Figure 2A, B). Immunohistochemistry was positive for CD34 (vascular component) and negative for HMB-45 and Melan-A.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eLipomas represent the most common benign mesenchymal tumors. They are broadly categorized into simple lipomas, composed solely of mature adipocytes, and fibrolipomas, which contain an admixture of adipose and fibrous tissue\u003csup\u003e[6]\u003c/sup\u003e. Histologically, they can be further classified as angiolipomas or intramuscular lipomas\u003csup\u003e[7-8]\u003c/sup\u003e. Within the intestines, angiolipomas predominantly arise in the submucosa or subserosa, with a higher incidence in the small bowel compared to the colon\u003csup\u003e[9]\u003c/sup\u003e. To evaluate the clinical relevance of lipomas causing intussusception, a literature search was conducted using PubMed (pubmed.ncbi.nlm.nih.gov), the free public database developed by the US National Library of Medicine (NLM). Employing the search strategy (\"lipoma\" OR \"angiolipoma\") AND \"intussusception\" for publications between January 2015 and January 2025, and applying predefined inclusion/exclusion criteria supplemented by manual review of reference lists, 635 articles related to \"lipoma\" were identified. Of these, 22 specifically addressed \"angiolipoma\", and only 6 reported cases occurring in the gastrointestinal tract\u003csup\u003e[4, 10-14]\u003c/sup\u003e. Most gastrointestinal angiolipomas are small (\u0026lt;2 cm) and asymptomatic. However, when tumors exceed 2 cm in size or undergo hemorrhagic rupture, they can precipitate gastrointestinal bleeding, intestinal obstruction, or intussusception\u003csup\u003e[15]\u003c/sup\u003e. Intussusception occurs precisely because the angiolipomatous mass acts as a \"lead point,\" propelled by peristalsis into the distal bowel lumen\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;The etiology of intussusception in adults differs fundamentally from that in children. Over 90% of adult cases have an identifiable pathological cause, broadly categorized as neoplastic or non-neoplastic\u003csup\u003e[17]\u003c/sup\u003e. Non-neoplastic causes account for only 30–40% of cases, including anatomic abnormalities (e.g., Meckel's diverticulum, intestinal adhesions) and inflammatory or infectious processes\u003csup\u003e[18-20]\u003c/sup\u003e. In contrast, neoplastic factors constitute 60–70% of etiologies, encompassing both malignant tumors (colorectal carcinoma, lymphoma, or metastatic cancer) and benign neoplasms (lipomas, gastrointestinal stromal tumors, or adenomatous polyps)\u003csup\u003e[21-23]\u003c/sup\u003e. Current management primarily involves surgical intervention. Comprehensive preoperative evaluation typically identifies the underlying cause, including the precise location of intussusception and presence of a pathological \"lead point\u003csup\u003e[24]\u003c/sup\u003e. The initial surgical step involves manual reduction of the intussuscepted bowel segment, followed by assessment for ischemic bowel necrosis and underlying tumor pathology. For benign tumors, surgical resection is generally curative. Reported recurrence rates following resection of benign lead points are less than 5%\u003csup\u003e[9]\u003c/sup\u003e.Gastrointestinal angiolipomas are exceptionally rare. Dr. Juan Sun et al. aggregated all reported cases over the past two decades, identifying only 30 documented instances. Their analysis revealed that these tumors predominantly affect middle-aged and elderly males, with the ileum and colon being the most common sites. Notably, small bowel involvement exceeds colonic occurrence\u003csup\u003e[9]\u003c/sup\u003e. Abdominal pain presents non-specifically; however, angiolipomas in the upper gastrointestinal tract typically manifest with hemorrhage, whereas those in the lower tract primarily cause pain and obstruction. Remarkably, during follow-up extending to 10 years post-resection, no recurrences were documented among the 30 patients. The diagnostic challenge lies in the non-specificity of abdominal symptoms, underscoring the critical role of abdominal CT. In the present case, the patient's longstanding gastric history initially directed evaluation toward upper GI pathology, leading to gastroscopy alone. Crucially, abdominal CT was not performed at initial symptom onset. Consequently, surgical intervention was delayed until bowel necrosis developed. While resection was ultimately performed, earlier imaging could have prevented progression to transmural compromise and mitigated risks of hemorrhagic shock or intra-abdominal infection.\u003c/p\u003e\n\u003cp\u003eIn summary, ileal angiolipoma represents a rare yet treatable etiology of adult intussusception. In the present case, preoperative CT identification of a fat-density mass with vascular enhancement proved crucial for differentiating this benign lesion from malignancies such as gastrointestinal stromal tumors (GISTs) or lymphoma. Complete surgical resection remains the gold standard for preventing recurrence and complications. Clinicians should include angiolipoma in the differential diagnosis of adults presenting with occult GI pain or unexplained intussusception, particularly when imaging demonstrates fat-containing lesions. The accumulation of additional cases remains necessary to elucidate its pathogenesis and optimize management strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patient for participation in this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWritten Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting this study's findings are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHaihua Yu found this case report. Zheng Shu and Zhe Li wrote the manuscript. Shengnan Lin analyzed the data. All authors have read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDupuis H, Lemaitre M, Jannin A, Douillard C, Espiard S, Vantyghem MC. Lipomatoses. Ann Endocrinol (Paris). 2024;85(3):231-247. doi:10.1016/j.ando.2024.05.003. \u003c/li\u003e\n\u003cli\u003eKransdorf MJ, Larsen BT, Goulding KA, Cumsky JL, Hwang S, Long JR. Angiolipoma: a review of 778 lesions in 344 patients. Skeletal Radiol. 2023;52(3):541-552. doi:10.1007/s00256-022-04075-9. \u003c/li\u003e\n\u003cli\u003eDilege E, Bozkurt E, Kulle CB, Bulutay P, Agcaoglu O. A rare tumor of the male breast \u0026quot;angiolipoma\u0026quot; Case report and review of literature. Ann Ital Chir. 2022;11:S2239253X22036945. Published 2022 Feb 25.\u003c/li\u003e\n\u003cli\u003eVara-Luiz F, Nunes G, Oliveira C, et al. 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Am Fam Physician. 2022;105(6):602-612.\u003c/li\u003e\n\u003cli\u003eSun J, Kang W, Zeng Z, Zhang Z, Wang X. Rare localization of angiolipoma in the gastrointestinal tract: a case series. J Int Med Res. 2020;48(9):300060520938589. doi:10.1177/0300060520938589. \u003c/li\u003e\n\u003cli\u003eNi X, Yin J, Chen L, Zhu Z. Endoscopic resection of a rare duodenal polypoid mass: duodenal angiolipoma. Rev Esp Enferm Dig. 2023;115(6):332-333. doi:10.17235/reed.2022.9268/2022. \u003c/li\u003e\n\u003cli\u003eLou XH, Chen WG, Ning LG, Chen HT, Xu GQ. Multiple gastric angiolipomas: A case report. World J Clin Cases. 2019;7(6):778-784. doi:10.12998/wjcc.v7.i6.778. \u003c/li\u003e\n\u003cli\u003eAlghamdi SA, Alshammery SM, Alamari MS, Alshehri MA, Alshahrani AS. An unusual case of gastric angiolipoma presenting with upper gastrointestinal bleeding. Oxf Med Case Reports. 2022;2022(11):omac119. 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World J Gastrointest Surg. 2018;10(6):70-74. doi:10.4240/wjgs.v10.i6.70. \u003c/li\u003e\n\u003cli\u003eYang Y, Jia D, Jiang C. Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception-a case report and literature review. World J Surg Oncol. 2022;20(1):44. Published 2022 Feb 23. doi:10.1186/s12957-022-02519-z. \u003c/li\u003e\n\u003cli\u003eZhu LB, Li PF, Xiao WH, Zhang PB, Li JQ, Sun MF. A distal ileum malignant peripheral nerve sheath tumor causing intussusception in a patient in China: a case report. World J Surg Oncol. 2017;15(1):29. Published 2017 Jan 19. doi:10.1186/s12957-017-1101-z \u003c/li\u003e\n\u003cli\u003ePanzera F, Di Venere B, Rizzi M, et al. Bowel intussusception in adult: Prevalence, diagnostic tools and therapy. World J Methodol. 2021;11(3):81-87. Published 2021 May 20. doi:10.5662/wjm.v11.i3.81\u003c/li\u003e\n\u003cli\u003ePatsikas MN, Papazoglou LG, Paraskevas GK. Current Views in the Diagnosis and Treatment of Intestinal Intussusception. Top Companion Anim Med. 2019;37:100360. doi:10.1016/j.tcam.2019.100360 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Angiolipoma, intussusception, Rare pathological type, Case Report","lastPublishedDoi":"10.21203/rs.3.rs-7534282/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7534282/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Angiolipoma, a rare benign intestinal tumor, is primarily diagnosed through abdominal imaging and pathological examination. Intestinal angiolipomas frequently cause intussusception, necessitating prompt surgical resection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation: \u003c/strong\u003eThis paper reports a 62-year-old female patient admitted to the First Affiliated Hospital of Shandong First Medical University with \"unprovoked paroxysmal abdominal pain for 3 months.\" Preoperative diagnosis indicated ascending colonic intussusception secondary to ileal angiolipoma. Pathological examination following surgical bowel resection confirmed the lesion as an (ileal) angiolipoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Given the rarity of this pathological entity in the intestinal tract, we present this case.\u003c/p\u003e","manuscriptTitle":"Ascending Colon Intussusception caused by Ileal Hemangiolipoma: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 01:32:26","doi":"10.21203/rs.3.rs-7534282/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d989fb57-8796-4696-b066-0562372c160c","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-25T01:32:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-25 01:32:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7534282","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7534282","identity":"rs-7534282","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}