Lipoma of the Small Intestine: A Cause for Intussusception in Adults

Role of clinical and multidetector computed tomography (MDCT) features in the prediction of patients with intestinal lipoma developing intussusception

Background

Intestinal lipoma is considered the most common benign tumor that causes intussusception. This retrospective case-control study aimed to present the clinical and multidetector computed tomography (MDCT) features between intestinal lipomas with and without intussusception and examine risk factors that predict intussusception caused by intestinal lipomas.

Methods

We retrospectively analyzed 281 adult patients diagnosed with intestinal lipoma by radiologists using whole-abdominal MDCT between January 2015 and August 2022. Patients were divided into adult intussusception (AI) and non-AI groups based on MDCT images. Univariate logistic regression was performed to identify risk factors for intestinal lipoma-induced intussusception.

Results

A total of 281 patients with intestinal lipomas were included in the study, with an average age of 68.0±11.3 years, and the male to female ratio was about 1:1.4. Among them, 24 patients developed lipoma-induced intussusception. Patients in the AI group presented with more abdominal pain (70.8% vs. 47.1%, P=0.03), nausea/vomiting (37.5% vs. 14.8%, P=0.009), hematochezia/melena (29.2% vs. 11.3%, P=0.02), and abdominal tenderness (66.7% vs. 24.9%, P<0.001). Lipomas were more common in the small bowel (224/281, 79.7%) than the large bowel (57/281, 20.3%). Lipomas in the AI group showed more heterogeneous hypodensity (41.7% vs. 15.6%, P=0.004), longer length (median, 2.2 vs. 1.2 cm, P<0.001), and larger volume (median, 4.1 vs. 0.6 cm3, P<0.001). In the univariate logistic regression, lipoma density [odds ratio (OR) =3.875, 95% confidence interval (CI): 1.609-9.331, P=0.003] and lipoma length (OR =3.216, 95% CI: 1.977-5.231, P<0.001) were risk factors for intestinal lipoma-induced intussusception.

Conclusions

More patients in the AI group have digestive tract symptoms than those in the non-AI group. Lipoma density and length are risk factors for intussusception in patients with intestinal lipoma. In addition, the common site of intestinal lipoma may have changed from the colon to the small intestine.

Small intestinal obstruction due to subserosa fibrolipoma in a 2-year-old child: A case report and literature review

Lipomas of the gastrointestinal tract (GIT) are generally rare. They are rare in children, and when they occur they are usually submucosa. Most of the submucosa lipomas of GIT are present in the colon (65%-75%) and small intestine (25%). In children, intestinal lipoma is a documented cause of pathological lead point intussusception, especially when located in the submucosa. The present case report is of subserosa lipoma in the distal ileum. A 2-year-old boy presented with features of intestinal obstruction which was preceded by a painless abdominal mass. In the absence of computerised tomography scan, he was operated, and histopathology examination confirmed the mass as pedunculated fibrolipoma arising from the subserosa and causing extrinsic compression of the ileum.

Intussusception Related to Small Intestinal Lipomas: A Case Report and Review of the Literature

Introduction

Adult intussusception is a rare disease that is difficult to diagnose and treat and is even rarer when it is caused by a lipoma of the small intestine. We reported a case of a small intestine lipoma combined with intussusception, which can guide people in future clinical work.

Case Presentation

A 51-year-old female was admitted to the hospital with “abdominal pain for 1 month.” Enhanced computed tomography (CT) of the abdomen suggested a lipoma in the left lower quadrant and a proximal intussusception. After excluding surgical contraindications, laparoscopic exploration was performed on the second day of admission, which showed a small amount of ascites in the abdominal cavity, a small intestine–small intestine-type intussusception about 20 cm from the ileocecal area and about 140 cm from the ileocecal area, and a mass of about 2×4 cm that was palpable by laparoscopic intestinal forceps, which was protruded into the intestinal cavity with a soft texture and sound mobility. A 5 cm-long incision was made above the mass to dissect into the abdomen layer by layer, and the diseased intestine was dislodged outside the abdominal cavity with oval forceps. The intestine was reduced by hand and observed for half an hour after reduction, and the blood circulation and peristalsis of the intestine were observed to be still sound. The intestine was dissected at 2 cm from the upper and lower margins of the mass using linear anastomosis to operate small intestine side-to-side anastomosis. The intestine was opened concurrently and closed with a linear anastomosis, using 3-0 absorbable thread to reinforce anastomosis intermittently. The procedure went smoothly, and the patient was discharged on the 5th postoperative day.

Conclusion

A small intestinal lipoma combined with small intestinal intussusception is rare in clinical practice and needs to be diagnosed by asking history detailedly, physical examination, and relevant ancillary tests such as abdominal CT. Laparoscopic-assisted small incision surgery for adult intussusception combines the advantages of laparoscopic surgery and laparotomy, operating simply and easily.

Intussusception in Adults: A Rare Etiology of Small Intestinal Obstruction

Small intestinal obstruction is a common surgical emergency that has a wide range of underlying etiologies. The most frequent causes of small intestinal obstruction include adhesions, hernias, and malignancies. The diagnosis of small intestinal obstruction is primarily dependent on the clinical findings, but imaging investigations are crucial to confirm the diagnosis and evaluate the complications. We report the case of a middle-aged woman with a complaint of abdominal pain for one week that was associated with abdominal distension and decreased bowel motion. Examination of the abdomen showed a distended abdomen. There was generalized tenderness, but no guarding or rigidity was noted. Initial laboratory investigation showed no derangement in the basic hematological and biochemical parameters. Abdominal CT was performed, which showed a segment of jejunojejunal intussusception causing a small intestinal obstruction. There was a well-defined, oval-shaped fat-attenuation mass lesion acting as a lead-point. Such radiological findings conferred the diagnosis of jejunojejunal intussusception due to jejunal lipoma. The patient underwent laparotomy, which confirmed the radiological finding. The intussusception was reduced, but a gangrenous intestine was observed. Resection of the affected intestine was performed, followed by a primary anastomosis. The patient recovered with no complications. Following the operation, oral feeding was started gradually according to the patient's tolerance. She was discharged after 10 days of hospitalization. At the follow-up visit after three months, the patient had no active symptoms. This case illustrated a rare etiology of small intestinal obstruction due to gastrointestinal lipoma. A computed tomography scan is strongly advised to reach the diagnosis and identify the lead points.

Small intestinal submucosal lipoma: a rare cause of secondary intussusception in a child

Background

Intestinal lipomas are benign, non-epithelial, intestinal tumors with an exceptionally rare localization at the ileum. Lipomas in the small intestine occur mainly in elderly patients and seldom occur in childhood. They are frequently asymptomatic, possibly due to their slow growth. These tumors may act as a lead point of intussusception.

Case presentation

We report a rare case of double compounded ileo-ileal intussusception due to a submucosal intestinal lipoma in an 8-year-old female. To our knowledge, this is only the seventh pediatric case to be reported in the medical literature.

Conclusions

Small intestinal submucosal lipoma should be considered in case of intussusception in pediatric patients. Surgical resection seems sufficient in case of symptomatic intestinal lipoma with low morbidity.

An ileo-ileal intussusception secondary to polypoid lipoma in a child, a case report and review of the literature

•

Small intestinal lipoma is a rare reason for ileoileal intussusception but should be included in the differential diagnosis for lead points causing intussusception in children.

•

Dexamethasone as an adjuvant treatment may improve the outcome in cases of intussusceptions but this point needs future researches.

•

Intermittent attacks of small intestinal intussusception may lead to dilation of the distal segment (Intussuscipiens). This mechanism may delay vascular compromise.

•

High level of clinical suspicion needs to diagnose intussusception with unusual presentation.

Background

Intramuscular intestinal lipoma is one of the rare benign tumours of the small intestine in children and acts as a lead point of intussusception.

Presentation of case

We describe a case in which a 4-year-old boy presented with recurrent attacks of colicky abdominal pain and non-bilious vomiting. Abdominal examination was irrelevant. Per rectum (PR) examination indicated an empty rectum without red currant jelly stool and non-palpable mass. Abdominal ultrasonography revealed a target sign of intussusception. After a period of conservative treatment, the child passed normal coloured and well-formed stool. Exploratory laparotomy referred to a long segment ileo-ileal intussusception with a polypoid lipoma as a lead point. Microscopic examination showed a benign non-capsulated intramuscular ileal lipoma.

Discussion

Small bowel lipoma produces symptoms of intermittent bowel obstruction. Herein, the child presented with non- bilious vomiting, we attribute this to reflex sympathetic stimulation of the pylorus leading to pylorospasm.

Conclusion

Small intestinal lipoma is a rare finding in children that may cause intussusception which does not resolve spontaneously.

Complete small bowel obstruction without intussusception due to a submucosal lipoma

Submucosal lipomas of the small bowel are rare, often asymptomatic, benign tumors. Large lesions may present with acute symptoms such as a bowel obstruction from an intussusception or acute hemorrhage. Acute findings such as these require operative intervention. In this case, we present a 53-year-old female with a complete small bowel obstruction secondary to a submucosal lipoma without signs of an intussusception.