{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:14:09Z","timestamp":1788261249826,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Adult intussusception is rare, accounting for approximately 5% of all intussusceptions and 1\u20135% of adult bowel obstructions, whereas the ileo\u2013ileo\u2013colic subtype is exceptionally uncommon. We report a rare case of ileo\u2013ileo\u2013colic intussusception caused by an ileal lipoma and complicated by spontaneous ileal rupture and rectal hemorrhage, emphasizing the diagnostic challenge and proposing the hypothesis that mesenteric anatomical variability may have contributed to its pathophysiology. Case Presentation: A 61-year-old man presented with progressive abdominal distension, right lower quadrant pain and mass, and signs of bowel obstruction. Contrast-enhanced abdominal CT showed an ileo\u2013ileo\u2013colic intussusception extending into the ascending colon, with a typical target sign and marked ischemic changes involving the ileal loops. Emergency laparotomy confirmed a complex ileo\u2013ileo\u2013colic intussusception extending into the right colon, with an ileal lipoma acting as the lead point. The intussuscepted bowel had undergone spontaneous rupture with active bleeding, explaining the rectal hemorrhage. The patient underwent right hemicolectomy with ileocecal resection and side-to-side ileocolic anastomosis. Histopathological examination confirmed a submucosal ileal lipoma associated with transmucosal ischemic necrosis. Recovery was uneventful, and no recurrence or late complications were observed at 6- and 12-month follow-up. Conclusions: This case highlights an exceptionally rare and severe presentation of adult intussusception. Early CT diagnosis and prompt surgical resection are essential when ischemia, necrosis, or failed reduction are present. Mesenteric anatomical variability is proposed as a plausible contributing factor to the extensive telescoping and vascular compromise observed in this patient, a hypothesis that warrants further anatomical investigation.<\/jats:p>","DOI":"10.3390\/reports9030293","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T09:48:36Z","timestamp":1788256116000},"page":"293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rare Adult Ileo\u2013Ileo\u2013Colic Intussusception Caused by an Ileal Lipoma with Spontaneous Ileal Rupture and Rectal Hemorrhage: A Case Report with a Hypothesis-Generating Discussion of Mesenteric Anatomical Variability"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5751-9263","authenticated-orcid":false,"given":"Salvatore","family":"Pezzino","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6515-0130","authenticated-orcid":false,"given":"Mariacarla","family":"Castorina","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7067-900X","authenticated-orcid":false,"given":"Stefano","family":"Puleo","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-4107","authenticated-orcid":false,"given":"Sergio","family":"Castorina","sequence":"additional","affiliation":[{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"},{"name":"Department of Medical, Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref_1","first-page":"315","article-title":"Adult Intussusception: Still a Challenging Diagnosis for the Surgeon","volume":"88","year":"2023","journal-title":"Rev. Gastroenterol. Mex. (Engl. Ed.)"},{"key":"ref_2","unstructured":"Lewis, C.R., and Conner, J.N. (2026). Intussusception in Adults. StatPearls, StatPearls Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00423-024-03429-2","article-title":"Adult Intussusception: A Systematic Review of Current Literature","volume":"409","author":"Chand","year":"2024","journal-title":"Langenbecks Arch. 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