A rare cause of childhood ileus: giant mesenteric lipoma and a review of the literature

Radiological manifestations of benign mesenteric lipoma that presented with acute intestinal obstruction: A case report

Background

Intestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies.

Case presentation

We report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well.

Conclusions

Patients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation.

A rare lipoma site in a 1-year-old boy

Lipomas are benign tumors composed of mature adipocytes. A 1-year-old-male baby was admitted to the hospital with a history of an abdominal mass, which had been incidentally detected by a local pediatrician. upon examining the child for a complaint of distention and chronic diarrhea. An ultrasound and computed tomography scan were performed, and findings revealed a fat mass, which was confirmed by laparotomy and microscopic results. At laparotomy, a soft yellow mass was found attached to the mesentery of the jejunum. The mass was enucleated without anastomosis, and the patient was followed up 4 months postoperatively with regular clinical examination and abdominal ultrasonography. This case was examined and reported in this study because lipomas are very rarely present in the mesentery of the intestine, especially at this early age.

Benign mesenteric lipomatous tumor in a child: a case report and literature review

BACKGROUND

Lipomatous tumors are the most common type of soft-tissue tumors. Benign lipomatous tumors are lipomas and lipoblastoma. We herein report a case of benign mesenteric lipomatous tumor and the largest collection of known benign mesenteric lipomatous tumors in children in the literature.

CASE PRESENTATION

A 3-year-old girl presented with repeated dull abdominal pain and left abdominal mass swelling. On a physical examination, the child had a soft, moderately distended left abdomen that was not tender when palpated. Computed tomography and magnetic resonance imaging demonstrated a large fatty mass within the mesentery, measuring approximately 8 × 6 cm. The mass extended from the right upper quadrant to the lower pole of the kidneys. Laparotomy with resection of the mesenteric tumor was performed under general anesthesia. A well-capsuled tumor was a soft, yellow mass and found loosely attached to the mesenterium of the ileum. A histopathological examination demonstrated the lobular proliferation of mature adipocytes. Atypical lipoblasts were not seen. These features are compatible with benign lipomatous tumor, such as lipoma or lipoblastoma with maturation.

CONCLUSION

In conclusion, benign mesenteric lipomatous tumors tend to be large in size over 10 cm in longitudinal length. However, resection is well tolerated in the vast majority of cases with benign post-operative courses.