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Introduction:
Intestinal Lipomatosis consists of diffuse lipomas in various regions from the small to large bowel. They can remain asymptomatic or present with complications such as Intussusception.
Discussion:
Intestinal lipomatosis complicated by Intussusception is a rare occurrence that has not been well documented. Rare condition management...
Context in source publication
Context 1
... present the case of a healthy 47 year-old Hispanic male, who presented to the emergency room with abdominal pain for 5 days. The pain started in the epigastric area and shortly there- after, became diffuse. He admitted to nausea, vomiting, sweating, and chills, without fever. Laboratory findings showed a white blood cell count of 14,000 per microliter of blood. Upon physical exam- ination the patient was in acute distress, anxious, and agitated. During examination of the abdomen there were no obvious lesions or discolorations. Bowel sounds were diminished and the abdomen was firm, distended, and tender to palpation. He expressed severe tenderness and guarding that was more pronounced at the right lower quadrant. Patient did not have frequency, urgency, dysuria, or hematuria, but did present with rectal bleeding. McBurney's sign was positive. A CT scan of the abdomen and pelvis was ordered to further investigate the severe abdominal pain. CT showed Ileocolic intussusception and surgery was scheduled ( Fig. ...
Citations
... Symptoms can become severe and require immediate medical intervention when small intestinal lipomatosis coexists with intussusception, bleeding, obstruction, or bowel perforation [7][8][9][10]. In this paper, we present a case of intestinal torsion and subsequent intestinal obstruction in a 58-year-old female patient, which is rare and attributed to diffuse submucosal infiltration of slight intestinal fat hyperplasia. ...
Patient: Female, 58-year-old
Final Diagnosis: Diffuse small intestinal lipomatosis
Symptoms: Abdominal swelling • feelings of nausea • vomiting • reduced ability to defecate for at least two days
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology • Radiology
Objective
Rare disease
Background
Diffuse intestinal lipomatosis is a rare condition that infiltrates mature fatty tissue into the intestinal submucosa and subserosa of the small or large intestine and can present with intestinal obstruction or torsion. This report is of the case of a 58-year-old woman who had acute torsion of the small bowel due to diffuse small intestinal lipomatosis.
Case Report
A 58-year-old woman, who was otherwise in good health, arrived at our Emergency Department experiencing sudden, intense pain in the lower abdomen. She also reported abdominal swelling, feelings of nausea, vomiting, and reduced ability to defecate for at least 2 days. The next morning, contrast-enhanced abdominal computed tomography (CT) scan was performed, showing diffuse thickening of the small intestinal wall with hypodensity, fatty density, lumen narrowing, and wall thinning. The small intestine demonstrated a whirlpool-like distribution in the lower right abdomen and localized thickening of the small intestinal wall, suggesting acute intestinal torsion. An hour later, an emergency operation was performed to remove part of the small intestine. Three days later, pathological results showed a thin intestinal wall, expansion of the mucosal layer and submucosa, and hyperplasia of adipose tissue.
Conclusions
This report presents a rare case of torsion and small bowel obstruction caused by diffuse intestinal lipomatosis and focuses on the abdominal enhanced CT scan, which showed diffuse thickening of the small intestine, with multiple areas of fat density and torsion of the small intestine in the right lower abdomen. Histopathology is also presented, with the result showing intestinal lipomatosis.
... In a descending order, lipomas are more frequent in the caecum, ascending, sigmoid, transverse, rectum, and descending colon (9). In 90% of cases, these lesions are localized in the intestinal submucosa, but occasionally they extend into the muscularis propria, while up to 10% are sub-serosal (10)(11). ...
Lipomatosis of the colon is rare in clinical practice although the majority of cases are found incidentally. In rare circumstances, patients may presents with acute complications such as bowel obstruction, intussusception, or perforation. Here we report a case of colonic lipomatosis that present as localized peritonitis mimicking acute appendicitis in a young COVID patient. Sixth case in the literature of intestinal perforation peritonitis in intestinal lipomatosis.
... Intestinal lipomatosis is usually asymptomatic, and no treatment is required unless it is complicated with intussusception, bleeding, obstruction, or bowel perforation [4]. A rare case is presented of intestinal infarction due to diffuse intestinal and mesenteric lipomatosis in a 39-year-old woman, treated by ileal resection and side-to-side enterocolic anastomosis. ...
Patient: Female, 39-year-old
Final Diagnosis: Acute intestinal infarction
Symptoms: Painful
Medication: —
Clinical Procedure: Intestinal resection
Specialty: Surgery
Objective
Unusual clinical course
Background
Although lipomas are common benign tumors of adipose tissue, diffuse lipomas involving the small bowel, large bowel, and mesentery are rare. Multiple non-encapsulated lipomas characterize diffuse intestinal and mesenteric lipomatosis. Intestinal lipomatosis can be asymptomatic or may result in complications such as intussusception, volvulus, intestinal obstruction, or hemorrhage due to mucosal ulceration. A rare case is presented of intestinal infarction due to diffuse segmental jejunoileal and mesenteric lipomatosis in a 39-year-old woman.
Case Report
A 39-year-old woman was admitted to the emergency department with a 12-hour history of diffuse abdominal pain, nausea, vomiting, and absent bowel movements. She had a known history of intestinal lipomatosis, diagnosed two years previously on abdominal computed tomography (CT) imaging. At surgery, segmental jejunoileal and mesenteric lipomatosis was identified associated with acute intestinal infarction. She underwent ileal resection with side-to-side enterocolic anastomosis.
Conclusions
Diffuse intestinal and mesenteric lipomatosis is a rare condition that can be associated with complications. To our knowledge, this is the first reported case to present with acute small bowel infarction.
... Enteric intussusception is the most common form in adults, occurring in 40% of cases. Lipomas are responsible for two-thirds of these cases; however, most of these cases are secondary to a solitary lipoma opposed to intestinal lipomatosis, which is rare and has only been documented in few previous case reports [2,[4][5][6]. The term intestinal lipomatosis is used to describe diffuse, multiple and circumscribed lipomas within the intestine [7]. ...
... The term intestinal lipomatosis is used to describe diffuse, multiple and circumscribed lipomas within the intestine [7]. Intestinal lipomatosis is a rare disease with an incidence of 0.04-4.5% at autopsy [4]. The pathogenic mechanisms involved in intestinal lipomatosis have not yet been identified; however, several etiological factors have been postulated. ...
... Intestinal lipomatosis is often asymptomatic; however, complications including upper gastrointestinal bleeding, colonic perforation, volvulus and intussusception can occur [2,4,6,9] and are often the first presentation of the condition. There is no consensus in regard to the ideal management approach of intussusception secondary to intestinal lipomatosis. ...
A 25-year-old man presented to the emergency department with severe abdominal pain and vomiting. He had previously presented 10 days prior with similar symptoms. Computed tomography imaging showed a large jejuno-jejunal intussusception. Multiple intestinal masses were identified intraoperatively with the rare diagnosis of intestinal lipomatosis later confirmed via histopathology. Diagnosis and management of rare surgical pathologies is always challenging. Intussusception should always be considered as a differential diagnosis for abdominal pain in adults, as adult intussusception is typically due to a structural abnormality with majority of cases requiring surgical intervention. Exploratory laparotomy with segmental resection and primary anastomosis proved to be a successful approach in our case, with the patient having an uneventful recovery. Follow-up has consisted of gastrointestinal endoscopy and colonoscopy, which have not demonstrated any further lipomas.
... The lead points for the intussusceptions are attributable to benign, malignant, or idiopathic causes [6]. Most patients with intestinal lipomatosis are asymptomatic; however, some present with subacute intermittent obstruction, colonic perforation, and rarely, intussusception [7]. Repeated intussusceptions can happen in a patient with multiple submucosal lipomas [8]. ...
Intussusception is a rare cause of bowel obstruction caused by both benign and malignant pathology. We are presenting the case of an elderly patient who had been diagnosed with irritable bowel syndrome for many years prior to presenting to us with ileocecal intussusception causing a small bowel obstruction. Laparoscopic resection of the terminal ileum and cecum was performed. Pathology revealed multiple submucosal lipomas as the underlying cause.
... There are other case reports described where an open surgery was necessary because preoperative findings suggested the necessity of large resection such as hemicolectomy. 18 Another reason for laparotomy was a large tumour and the high probability of malignancy due to localisation in the colon. 19 ...
Primary small bowel tumours are very uncommon accounting about 1% of all gastrointestinal tumours. Intestinal lipomas are a rare entity of benign tumours with an incidence at autopsy ranging from 0.04% to 4.5%, most being asymptomatic. Complications such as obstruction, haemorrhage, intussusception and perforation might demand invasive management. Among these, intussusception is the most rare complication of intestinal lipomas. Here, we present a case of intussusception in a 52-year-old female with a large intramural lipoma of the ileum.
INTRODUCTION
Intestinal Lipomatosis (IL) consists of diffuse lipomas in various regions from the small to large bowel.
Intestinal Lipomatosis, first described by Hellstrom in 1906, represents a rare clinical event with an incidence at autopsy ranging from 0.04% to 4.5%.
IL is often asymptomatic and is quite frequently discovered accidentally,when a radiological examination is made.
It sometimes can be characterized by the following clinical aspecific manifestations: diffuse or localized abdominal pain, constipation or rectal hemorrhage.
In Emergency Surgery, Intestinal Lipomatosis can be related to the following clinical scenarios: intestinal perforation, intussusceptions, obstruction or enteric bleeding.
Intestinal lipomatosis may be solitary or multiple, encapsulated lipomas or diffuse, unencapsulated
lobules of adipose tissue.
Ileocecal lipohyperplasia is characterised by submucosal infiltration of adipose tissue in the ileocecal valve (ICV).
Referring to the position in the bowel wall layers, three types of IL are described: submucous, subserous and mixed (submucous and subserous). Submucous lipomas are more frequent (90%) than subserous lipomas.
Although there are not any established guidelines for the management of IL, however in case of remittent symptoms or acute complications surgery remains the most accepted approach.
We report two cases of IL characterized by different clinical presentation.
Introduction
Colonic lipomatosis is defined as a poorly circumscribed, non-capsulated fat accumulation in the submucosal layer of the colonic wall. Clinical presentation varies from asymptomatic to acute surgical complications.
Presentation of case
We report the case of a 79-year old male who arrived at the Emergency Department complaining of worsening abdominal pain, fever and nausea. A CT scan revealed a periappendicular abscess extended to the ileocecal valve and also the presence of diffuse intramural fatty tissue of the ascending colon. The patient underwent surgery and a right hemicolectomy was performed. The final histological exam confirmed the diagnosis of gangrenous appendicitis with diffuse abscessualization of the ileocecal valve and the presence of submucosal lipomatosis of the ICV extending to the ascending colon. Patient was discharged at 11th-POD.
Discussion
Acute appendicitis can represent a complication, although rare, of colonic lipomatosis. The underlying mechanism can be explained by the obstruction of the stool discharge from the appendix caused by the thickened colonic wall due to lipomatosis. Despite the lack of established guidelines on the management of colonic lipomatosis, surgery remains the preferred treatment in case of acute complications.
Conclusion
Acute appendicitis is a rare clinical manifestation of colonic lipomatosis. As in the case of other acute complications, such as intussesception, surgery remains the preferred therapeutic approach.
