J Gastrointest Surg DOI 10.1007/s11605-015-2824-1
GI IMAGE
Submucosal Lipoma: a Rare Cause of Recurrent Intestinal Obstruction and Intestinal Intussusception Run-De Jiang 1 & Xu-Ting Zhi 1 & Bo Zhang 1 & Zhi-Qiang Chen 1 & Tao Li 1
Received: 26 March 2015 / Accepted: 8 April 2015 # 2015 The Society for Surgery of the Alimentary Tract
Abstract Intestinal lipomas are rare nonepithelial tumors that are usually detected incidentally. They are usually asymptomatic, but lipomas larger than 2 cm may become symptomatic due to obstruction, bleeding, or intussusception. Adult intussusception due to intestinal lipoma is a very rare condition. In this paper, we report a case of small bowel lipoma that became symptomatic due to intermittent obstruction episodes and ileo-ileal intussuception. Segmental ileal resection was performed, and histopathological examination of the resected specimen confirmed the diagnosis of lipoma. Keywords Lipomas . Intestinal intussusception . Obstruction . Surgery
Clinical Data A 50-year-old man was referred to our hospital because of long-standing, recurrent abdominal pain. He had had symptoms intermittently for about 12 years, and over the previous 1 month, the episodes of pain became more pronounced with radiation to his back. The patient’s past medical history was unremarkable, and he did not report any history of anemia or episodes of diarrhea or rectal bleeding. Abdominal examination revealed slight abdominal tenderness on the right lower quadrant and increased bowel sounds on auscultation. Laboratory tests including complete blood count, renal and liver function tests, blood coagulation, and tumor markers were all within normal limits except of a slight increased percentage of neutrophils (75.2 %, range 40–75 %). A computed tomography (CT) scan of the abdomen and pelvis revealed an ovoid mass of 4×3 cm in size (arrow) with thickened walls of the
* Tao Li [email protected] 1
Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan 250012, China
ileum and mildly dilated loops of proximal small bowel (Fig. 1a). The lesion showed fatty density and protruded into the lumen of the ileum causing a filling defect in ileum (Fig. 1b, arrow). Intestinal intussusception caused by lipoma was suspected, and surgical exploration was performed. On exploratory laparotomy, an ileo-ileal intussusception was found (Fig. 2a, arrow). After manual reduction, segmental ileal resection and primary anastomosis were performed and two submucosal masses were detected (Fig. 2b, arrow). Gross and pathological examination of the resected specimen revealed submucosal tumors of his ileum with features of benign lipoma (Fig. 2c, d). The postoperative course was uneventful, and the patient was discharged from hospital on the 8th day postoperatively.
Discussion Gastrointestinal lipomas are uncommon benign tumors of mesenchymal origin. They are the second most common benign tumors in the small intestine and account for only 5 % of all gastrointestinal tumors.1 Lipomas can appear in any part of the gut and are most commonly located in the colon (65 to 75 %, especially on the right side), small bowel (20 to 25 %), and occasionally in the foregut (
GI IMAGE
Submucosal Lipoma: a Rare Cause of Recurrent Intestinal Obstruction and Intestinal Intussusception Run-De Jiang 1 & Xu-Ting Zhi 1 & Bo Zhang 1 & Zhi-Qiang Chen 1 & Tao Li 1
Received: 26 March 2015 / Accepted: 8 April 2015 # 2015 The Society for Surgery of the Alimentary Tract
Abstract Intestinal lipomas are rare nonepithelial tumors that are usually detected incidentally. They are usually asymptomatic, but lipomas larger than 2 cm may become symptomatic due to obstruction, bleeding, or intussusception. Adult intussusception due to intestinal lipoma is a very rare condition. In this paper, we report a case of small bowel lipoma that became symptomatic due to intermittent obstruction episodes and ileo-ileal intussuception. Segmental ileal resection was performed, and histopathological examination of the resected specimen confirmed the diagnosis of lipoma. Keywords Lipomas . Intestinal intussusception . Obstruction . Surgery
Clinical Data A 50-year-old man was referred to our hospital because of long-standing, recurrent abdominal pain. He had had symptoms intermittently for about 12 years, and over the previous 1 month, the episodes of pain became more pronounced with radiation to his back. The patient’s past medical history was unremarkable, and he did not report any history of anemia or episodes of diarrhea or rectal bleeding. Abdominal examination revealed slight abdominal tenderness on the right lower quadrant and increased bowel sounds on auscultation. Laboratory tests including complete blood count, renal and liver function tests, blood coagulation, and tumor markers were all within normal limits except of a slight increased percentage of neutrophils (75.2 %, range 40–75 %). A computed tomography (CT) scan of the abdomen and pelvis revealed an ovoid mass of 4×3 cm in size (arrow) with thickened walls of the
* Tao Li [email protected] 1
Department of General Surgery, Qilu Hospital, Shandong University, 107 West Wen Hua Road, Jinan 250012, China
ileum and mildly dilated loops of proximal small bowel (Fig. 1a). The lesion showed fatty density and protruded into the lumen of the ileum causing a filling defect in ileum (Fig. 1b, arrow). Intestinal intussusception caused by lipoma was suspected, and surgical exploration was performed. On exploratory laparotomy, an ileo-ileal intussusception was found (Fig. 2a, arrow). After manual reduction, segmental ileal resection and primary anastomosis were performed and two submucosal masses were detected (Fig. 2b, arrow). Gross and pathological examination of the resected specimen revealed submucosal tumors of his ileum with features of benign lipoma (Fig. 2c, d). The postoperative course was uneventful, and the patient was discharged from hospital on the 8th day postoperatively.
Discussion Gastrointestinal lipomas are uncommon benign tumors of mesenchymal origin. They are the second most common benign tumors in the small intestine and account for only 5 % of all gastrointestinal tumors.1 Lipomas can appear in any part of the gut and are most commonly located in the colon (65 to 75 %, especially on the right side), small bowel (20 to 25 %), and occasionally in the foregut (
