adult intussusception accounts for 5 - 10% of all intussusecptions , and it has a leading point in more than 90% of all cases [ 1 , 2 ] . finding the leading point of adult intussusception is difficult for physicians because of its rare incidence and nonspecific clinical manifestations . colonic lymphangioma may be a rare cause of adult intussuseption , and only five cases have reported in the english and the japanese literature [ 3 - 7 ] . recently , colonic lymphangioma has been diagnosed more frequently during colonoscopy and has been removed by using an endoscopic procedure . however , large colonic lymphangiomas with complications require surgical resection . we report a case of adult intussusceptoin due to cecal lymphangioma that was diagnosed by imaging studies before surgery . a 30-year - old female was admitted to our hospital with right lower abdominal pain for one day . her history was unremarkable . on admission , her body temperature was 37 , her blood pressure was 120/80 mm hg , and her heart rate was 78 beats / min . a physical examination revealed right lower quadrant pain and tenderness , but no rebound tenderness was detected . laboratory tests , including a peripheral blood test , a biochemical test and a urinalysis , were all normal , except for the white blood cell count ( 12,700/mm ) . the color doppler image showed that flow signals at the bowel wall were preserved ( fig . computed tomography ( ct ) revealed the same cystic lesion in the cecum and showed a " bowel within bowel " configuration , as well as vessels and mesenteric fat within the bowel 's lumen ( fig . an emergency laparotomy was performed , with a diagnosis of intussusception due to cecal lymphangioma . during the operation , we found an ileocolic intussusceptions , and an ilececectomy was performed after manual reduction . macroscopically , a 9-cm submucosal tumor with fluctuations and with a round , smooth , and broad base was seen in the cecum ( fig . histological examination found that the cyst was located below the normal mucosal membrane and was surrounded by flat endothelial cells ( fig . 4 ) . immunohistochemstry showed negative for carcinoembrionic antigen ( cea ) and positive for factor viii . the patient 's postoperative course was uneventful , and she was discharged five days after the operation . lymphangioma is a benign tumor that consists of several expanded lymphatics surrounded by benign endothelial cells and cystic spaces containing chylous , seroangeous or serous material . lymphangioma occurs most often in the head and neck , axilla , or groin in young children , but it is incidentally diagnosed during adulthood in the intra - abdomen and retroperitoneum . lymphangioma in the gastrointestinal tract is extremely rare . besides the stomach , lymphagiomas of the gastrointestinal tract have been reported to occur in the small intestine ( mostly in the jejunum ) , the esophagus , and the colon . cystic lymphangioma of the colon is also extremely rare ; only 79 cases of colonic lymphangioma have been reported in the english and japanese literature . a colonic lymphangioma is small and nearly asymptomatic , so most reported cases are detected incidentally during colonoscopy or barium enema . if symptoms arise , patients complain of an acute abdominal pain , flank pain , nausea and vomiting , which clinically mimic symptoms of acute appendicitis or intestinal obstruction . our patient presented with acute abdominal pain for one day and a palpatable mass , with tenderness on her right lower quadrant . these include tumors ( 52% ) , postoperative causes ( 36% ) , idiopathic causes ( 8% ) , and so on . for the diagnosis of intussusception in adults , computed tomography has been reported to be the most useful method . radiologic studies showed that our patient 's ileocecal intussusception occurred due to a cecal cystic mass , but she had no sign of an intestinal obstruction . the ct findings of intussusception , as shown in our case , are characterized by the presence of a thickened bowel wall , as well as soft tissue and fat attenuation . the lead point detected in our case was a 9-cm cystic mass in the cecum . ultrasonography confirmed the cecal cystic mass , and our radiologist suggested intussusception due to a cecal lymphangioma . to our knowledge , only six cases ( including our present case ) of colonic lymphangioma in adults have developed into an intussusception ; five lesions were located in the cecum and one in the transverse colon ( table 1 ) [ 3 - 7 ] . all were in females , all the tumors were larger than 5 cm , and all patients underwent a laparotomy . incomplete fixation of the colon and cecum was described in four patients , and we thought this might have been partially responsible for the chronic recurrent intussusception . even though an endoscopic polypectomy or an endoscopic mucosal resection may be recommended for pedunculated or semipedunculated colonic lymphangiomas less than 2 cm in size [ 8 , 12 , 13 ] , a large or symptomatic colonic lymphangioma should be treated with a limited bowel resection or a tumor resection .
we present a rare case of adult intussusception due to cecal lymphangioma . 
 a 30-year - old female was admitted to our hospital with abdominal pain and a palpatable mass on the right lower quadrant . 
 preoperative radiologic studies by ultrasound and computed tomography showed ileocolic intussusception with a multiseptated cystic tumor as a leading point on the cecum . 
 an ileocecectomy was performed , and the postoperative course was uneventful . 
 histopathology showed a cecal lymphangioma . 
 although endoscopic polypectomy or endoscopic mucosal resection is recommended for pedunculated or semi - pedunculated colonic lymphangiomas less than 2 cm in size , it is proper to treat large or symptomatic colonic lymphangiomas with limited a bowel resection or a tumor resection .