Obscure gastrointestinal bleeding caused by small bowel lipoma

Obscure gastrointestinal bleeding from a large jejunal lipoma treated using an endoscopic unroofing technique with double balloon enteroscopy: a case study

Small intestinal lipomas are rare, but may cause obscure gastrointestinal bleeding. The endoscopic unroofing technique excises only the upper third of the lipoma and allows both histological confirmation and complete treatment with minimal risk of perforation. We present a rare case of obscure gastrointestinal bleeding caused by a jejunal lipoma. A 75-year-old man on antiplatelet therapy presented to our department with melena and anemia. Computed tomography revealed he had a 45-mm jejunal submucosal tumor with fat attenuation. Endoscopic resection using an endoscopic unroofing technique with double balloon enteroscopy was successfully performed. The tumor was confirmed to be a lipoma.

Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas: Report of two cases

BACKGROUND

Most small intestinal lipomas are treated surgically, and some require repeated surgeries for multiple lipomas. However, application of endoscopic submucosal dissection (ESD) technology in the deep small intestine is rarely reported owing to the special anatomical structure of the small intestine, medical equipment limitations, and the lack of relevant experience among endoscopists.

CASE SUMMARY

Two patients with small intestinal lipomas treated at the Air Force Medical Center from November 2015 to September 2019 were selected to undergo balloon-assisted ESD to treat the lipomas and explore the technical feasibility and safety of ESD for treating small intestinal lipomas. The two patients successfully underwent balloon-assisted ESD to treat four small intestinal lipomas, with a complete resection rate of 100% (4/4), without intraoperative or postoperative bleeding, perforation, or other complications. After 3-6 mo of postoperative follow-up, the clinical symptoms caused by the lipomas were significantly relieved or disappeared after treatment.

CONCLUSION

Balloon-assisted ESD is a safe and reliable new method for treating deep intestinal lipomas and shows good clinical feasibility.

Ileocolic intussusception due to intestinal lipoma in an adult patient

Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.

A systematic review of symptomatic small bowel lipomas of the jejunum and ileum

Introduction

Small bowel lipomas are rarely encountered benign adipose growths found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. We aim to aid clinical decision-making and improve patient outcomes through this comprehensive review.

Methodology

The terms 'small bowel,' 'small intestine,' 'jejunum' and 'ileum' were combined with 'lipoma.' EMBASE, Medline and PubMed database searches were performed. All papers published in English from 01/01/2000-31/12/2019 were included. Simple statistical analysis (t-test, Anova) was performed.

Results

142 papers yielded 147 cases (adults = 138, pediatric = 9). Male = 88, female = 59 (average age = 49.9 years). Presenting symptoms: abdominal pain = 68.7%; nausea/vomiting = 35.3%, hematochezia/GI bleeding = 33.3%; anaemia = 10.9%; abdominal distension = 12.2%; constipation = 8.9%; weight loss = 7.5%. Mean preceding symptom length = 58.1 days (symptoms >1 year excluded (n = 9)). Diagnostic imaging utilised: abdominal X-Ray = 33.3%; endoscopy = 46.3%; CT = 78.2%; ultrasound = 23.8%. 124/137 (90.5%) required definitive surgical management (laparotomy = 89, laparoscopcic = 35). 9 patients were successfully managed endoscopically. Lipoma location: ileum = 59.9%, jejunum = 32%, mesentery = 4.8%. Maximal recorded lipoma size ranged 1.2-22 cm.Mean maximum lipoma diameter and management strategy comparison: laparotomy 5.6 cm, laparoscopic = 4.4 cm, endoscopic = 3.7 cm, conservative = 4.5 cm. One-way Anova test, p value = 0.21. Average length of stay (LOS) was 7.4 days (range = 2-30). T-test p value = 0.13 when comparing management modalities and LOS. 4 complications, 0 mortality.

Conclusions

Important previously undocumented points are illustrated; a clearer symptom profile, diagnostic investigations utilised, size and site of lipomas, types and effectiveness of management modalities, associated morbidity and mortality. Open surgery remains the primary management. No statistically significant difference in LOS and lipoma size is demonstrated between management strategies. Endoscopic and laparoscopic techniques may reduce utilising invasive surgery in the future as skillset and availability improve.

Gastrointestinal hemorrhage caused by small intestinal benign tumors: 2 cases report

Gastrointestinal bleedings caused by small intestinal tumors are rare and difficult to diagnose because they are not easy to access to the conventional endoscopy. We report two cases, one of them from proximal jejunum and the other one from ileal intestine complicated by intussusception. The two cases were admitted in the emergency department for hematochezia and melena, the diagnosis was established by enhanced helical computed tomography angiography.

Management of small bowel polyps: A literature review

Despite the small bowel comprising 90% of the mucosal surface area of the gastrointestinal tract, it is a rare site for neoplasia and only accounts for a little over 3% of the tumors that arise in the digestive tract. Benign small bowel lesions include lipomas, lymphangiomas, leiomyomas, neurofibromas, nodular lymphoid hyperplasia and adenomas, many of which are precursors to malignant lesions. Several polyposis syndromes are associated with small bowel polyps as well, including familial adenomatous polyposis syndrome, lynch syndrome, Peutz-Jeghers syndrome, Cowden syndrome and juvenile polyposis syndrome. Our aim was to review non-malignant small bowel polyps and discuss the prevalence, typical location, clinical presentation, diagnosis, endoscopic and histologic description and lastly management of each of these lesions.

A unique case of massive gastrointestinal bleeding

OBJECTIVES

Lipomas are the second most common benign tumors of the small bowel, and most lipomas are asymptomatic. However, lipomas with diameters of >20 mm tend to be symptomatic, for example, to cause bleeding, obstructive jaundice, abdominal pain, intestinal obstruction, intussusception, and/or perforation.

METHODS/RESULTS

We report a case of massive gastrointestinal bleeding from a jejunal lipoma combined with intussusception. A preoperative diagnosis of gastrointestinal bleeding derived from a jejunal lipoma combined with intussusception was made based on double-balloon enteroscopy and contrast-enhanced computed tomography, and partial resection of the small intestine was performed. After surgery, there was no additional gastrointestinal bleeding.

CONCLUSION

There have only been a few reports about cases of jejunal lipoma involving simultaneous bleeding and intussusception. Double-balloon enteroscopy is useful for preoperatively diagnosing bleeding from a lipoma. Our case highlights that jejunal lipoma can cause massive unexplained gastrointestinal bleeding.

Successful Endoscopic Submucosal Dissection of a Large Terminal Ileal Lipoma

A 78-year-old woman who had recurrent right lower abdominal pain for about 1 year underwent computed tomography (CT) because of a follow-up observation 1 year after right breast cancer surgery. CT revealed a tumor in the colon. The patient was referred to our hospital for detailed examinations. An abdominal CT showed a low-density tumor of approximately 30 mm in the ascending colon, and the CT density inside the tumor was same as that of fatty tissues. A subsequent colonoscopy showed a submucosal tumor (SMT) in the proximal ascending colon developing from the terminal ileum. A colonoscopic ultrasonography revealed that the SMT was a high-echoic mass mainly localized in the submucosal layer. Based on the findings from CT, colonoscopy, and colonoscopic ultrasonography, the SMT was diagnosed as a pedunculated lipoma originating from the terminal ileum and treated with endoscopic submucosal dissection (ESD) because of recurrent abdominal pain. The 40-mm tumor was resected en bloc without complications. ESD may be more appropriate than polypectomy and surgery for removal of small intestinal tumors, because ESD allows direct visualization of the cutting line and exactly dissects the submucosal layers without damaging the muscular layers. ESD is a potentially useful treatment to remove intestinal lipomas.

Obscure gastrointestinal bleeding caused by small intestinal lipoma: a case report

BACKGROUND

Small intestinal lipomas are rare, usually asymptomatic, and most commonly encountered incidentally during investigation of the gastrointestinal tract for another reason. However, they may cause obscure gastrointestinal bleeding.

CASE PRESENTATION

We report a case of obscure gastrointestinal bleeding due to a small intestinal lipoma. A 69-year-old Japanese man on antiplatelet therapy presented to our department with tarry stools and anemic symptoms. A small intestinal tumor was detected by capsule endoscopy and double-balloon endoscopy. After laparoscopic resection, the tumor was confirmed to be a lipoma.

CONCLUSIONS

Small intestinal lipomas are difficult to detect by conventional modalities, but capsule endoscopy and double-balloon endoscopy are good modalities for the diagnosis of small intestinal lipomas. Treatment of small intestinal lipomas should be selected carefully, considering the tumor size, size of stalk, administration of antithrombotic therapy, and endoscopic operability.

Lipoma of the small intestine treated with endoscopic resection

We report a case of lipoma of the small intestine that was treated by endoscopic resection. A 79-year-old man who complained of tarry stool was diagnosed as having jejunal tumor at a neighboring clinic. Computed tomography (CT) and enteroscopy demonstrated an ulcerating jejunal mass. Because the tumor was considered to be the source of bleeding, we removed it under double-balloon endoscopy with a SB knife without any procedure-related complications. Histological examination revealed that the tumor was composed of mature adipose tissue, compatible with lipoma. SB knife, a scissors-type device for submucosal dissection, may be more appropriate than snare polypectomy for removal of small bowel tumors, because it can control bleeding readily and satisfactorily. Our experience suggests that submucosal dissection may be an appropriate procedure for removal of lipomas of the intestine. Endoscopic resection with SB knife and double-balloon endoscopy is a potential option to avoid surgical resection in the management of tumors of the small intestine.

Large benign submucosal lipoma presented with descending colonic intussusception in an adult

Patient: Female, 34

Final Diagnosis: Lipoma of the large intestine

Symptoms: Abdominal pain • bloating • blood in stool • constipation • lose of appetite • nausea

Medication: —

Clinical Procedure: —

Specialty: Surgery

Adult intussusceptions caused by a lipoma in the jejunum: report of a case and review of the literature

Intussusceptions in adults is rare. Gastrointestinal lipomas are rare benign tumors and intussusceptions due to a gastrointestinal lipoma constitutes an infrequent clinical entity. Lipoma may develop as a benign tumor in all organs and rarely in large or small intestine. The present report describes a case of jejunojejunal intussusceptions in an adult with a history of colicky upper abdominal pain. Ileo-ileal invagination was diagnosed by computed tomography scan. Exploratory laparotomy revealed jejunojejunal intussusceptions secondary to a lipoma which was successfully treated with segmental intestinal resection. A review of the literature is also performed regarding this rare association revealing the diagnostic and therapeutic debates that exist. ABSTRACT (FRENCH): L'invagination chez les adultes est rare. Les lipomes gastro-intestinaux sont de rares tumeurs bénignes et l'invagination intestinale due à un lipome gastro-intestinal constitue une entité clinique trés rare. Le lipome peut se développer comme une tumeur bénigne dans tous les organes et rarement dans l'intestin grêle ou le colon. Le présent rapport décrit un cas d'invagination jéjunojéjunale chez un adulte avec une histoire de douleurs abdominales. Iléo-iléale invagination a été diagnostiquée par tomodensitométrie. Une laparotomie exploratrice a révélé l'existence d'une invagination jéjunojéjunale secondaire à un lipome qui a été traitée avec succès par une résection intestinale segmentaire. Une revue de la littérature est également effectuée au sujet de cette association rare révélant les débats diagnostiques et thérapeutiques qui existent.

Giant lipoma of the small bowel associated with perforated ileal diverticulum

The authors present a rare case of the middle aged man who presented with a typical history and clinical findings suggestive of an acute appendicitis. After initial assessment, he required a surgical intervention. Operation findings revealed a perforated ileal diverticulum into a giant lipoma of the small bowel. The patient made a good postoperative recovery.

Laparoscopic resection of a small bowel lipoma with incidental intussusception

Small bowel lipomas, which can cause intussusception and gastrointestinal bleeding, can be managed with laparoscopic resection when diagnosed preoperatively.

Background:

Small bowel tumors are rare entities that often present with nonspecific symptoms. The diagnosis is more likely in patients with occult gastrointestinal bleeding of unknown origin or in adults with small bowel intussusception. Even with exhaustive diagnostic testing, small bowel tumors are often not diagnosed preoperatively. Because 60% to 70% of small bowel tumors are malignant, surgical excision is always recommended.

Methods:

We report the case of a 73-year-old man with occult gastrointestinal bleeding. A small bowel tumor was discovered only after video capsule endoscopy, computed tomography, and multiple endoscopies were performed.

Results:

The patient underwent laparoscopic exploration. An incidental intussusception made the tumor simple to identify. By extending the umbilical port, the tumor was easily removed. The final pathology demonstrated a submucosal lipoma.

Conclusions:

Small bowel lipomas can cause intussusception and gastrointestinal bleeding. When diagnosed preoperatively, laparoscopic resection is feasible.

Ileal lipoma - a rare cause of ileocolic intussusception in adults: Case report and literature review

The occurrence of intussusception in adults is rare, accounting for less than 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. The child to adult ratio is more than 20:1. We report a rare case of ileocolic intussusception in an adult secondary to an ileal lipoma.

Application of laparoscopy in the management of obscure gastrointestinal bleeding

Gastrointestinal (GI) bleeding is considered obscure when it persists or recurs after negative endoscopy. Small bowel lesions account for approximately 1-fourth of cases of obscure GI bleeding. These lack specific clinical symtoms and signs, and tend to be inaccessible to routine examinations. The management of patients with intermittent obscure GI bleeding poses both diagnostic and therapeutic challenges. The aim of this study was to report the importance of laparoscopy in diagnosing and treating small bowel lesions responsible for obscure bleeding in 5 patients with subacute presentations. Data were collected from 2 hospitals' in-patient records and a prospective database. All patients underwent laparoscopic exploration. After the identification of the diseased segments, laparoscopy-assisted segmental resection of the small bowel and enteroentorostomy were carried out in all cases. This approach enabled a successful minimally invasive treatment of the obscure GI bleeding. The overall procedure was safe and our results were satisfactory.

Midgut pain due to an intussuscepting terminal ileal lipoma: a case report

Introduction

The occurrence of intussusception in adults is rare. The condition is found in 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. The child to adult ratio is 20:1.

Case presentation

A 52-year-old Irish Caucasian woman was investigated for a 3-month history of intermittent episodes of colicky midgut pain and associated constipation. Ileocolonoscopy revealed a pedunculated lesion in the terminal ileum prolapsing into the caecum. Computed tomography confirmed a smooth-walled, nonobstructing, low density intramural lesion in the terminal ileum with secondary intussusception. A laparoscopic small bowel resection was performed. Histology revealed a large pedunculated polypoidal mass measuring 4 × 2.5 × 2 cm consistent with a submucosal lipoma. She had complete resolution of her symptoms and remained well at 12-month follow-up.

Conclusion

This case highlights an unusual cause of incomplete small bowel obstruction successfully treated through interdisciplinary cooperation. Ileal lipomas are not typically amenable to endoscopic removal and require resection. This can be successfully achieved via a laparoscopic approach with early restoration of premorbid functioning.