Midgut pain due to an intussuscepting terminal ileal lipoma: a case report
TL;DR: This case highlights an unusual cause of incomplete small bowel obstruction successfully treated through interdisciplinary cooperation and can be successfully achieved via a laparoscopic approach with early restoration of premorbid functioning.
Abstract: 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.
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Journal Article•
TL;DR: It is indicated that intussusception, although rare in adults, should be considered in the differential diagnosis of abdominal pain and it should be taken into consideration that lymphangioma is one of the possible lesions that can cause intussuception.
Abstract: Adult intussusception is a relatively rare clinical entity. Almost 90% of cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point. Lymphangioma of the small bowel is an unusual tumour that has been rarely reported to cause intussusception. In this paper, we present a rare case of adult intussusception due to jejunal lymphangioma. A 22-year-old female patient with a medical history significant for anaemia presented with intermittent colicky abdominal pain, diarrhoea and oedema of the inferior limbs for the past three months. Ultrasonography and CT scan revealed a typical target sign with dilated intestinal loops. At laparotomy, a jejuno-jejunal intussusception was found. Partial resection of the jejunum was performed. Macroscopic examination of the surgical specimen revealed a pedunculated polyp measuring 2 cm in diameter. Histological sections of the polyp revealed in the lamina propria and submucosal layer of the jejunum several markedly dilated thin-walled lymphatic spaces lined with single layers of flat endothelial cells. The final pathologic diagnosis was submucosal lymphangioma. This case report indicates that intussusception, although rare in adults, should be considered in the differential diagnosis of abdominal pain. Moreover, it should be taken into consideration that lymphangioma is one of the possible lesions that can cause intussusception.
9 citations
TL;DR: Small submucosal ileal lesion is difficulty to localize when laparoscopic surgery, but localization by radiologic intervention is effective and harmless and could be performed intracorporeally.
2 citations
Cites background from "Midgut pain due to an intussuscepti..."
...[5] 52 F Abdominal pain Intussusception Lipoma Terminal ileum 40 Laparoscopy, intracorporeal anastomosis by staple Yes No...
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Journal Article•
TL;DR: A case of lipoma located in small intestine in a patient presenting with perforation peritonitis is reported, and it is reported that lipoma arises from adipocytes.
Abstract: Lipoma arises from adipocytes. Lipomas are benign, slow growing tumors, and are generally found in subcutaneous tissue of the proximal extremities and trunk. The gastrointestinal (GI) tract is an uncommon localization for lipoma, but if found; their most common localization is the colon. We report a case of lipoma located in small intestine in a patient presenting with perforation peritonitis.
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TL;DR: Malignancy is associated with intussusception much more frequently than was appreciated in earlier literature and with this in mind, the treatment of choice for all types of int Mussusception in adults is resection without reduction whenever possible.
Abstract: Two important points should be remembered in treating intussusception in adults: 1. 1. Malignancy is associated with intussusception much more frequently than was appreciated in earlier literature. It was associated with 24 per cent of cases of enteric intussusception and 54 per cent of all colonic intussusception in this report. 2. 2. With this in mind, the treatment of choice for all types of intussusception in adults is resection without reduction whenever possible.
451 citations
TL;DR: When an intussusception is encountered in adults, an underlying pathologic process usually can and should be determined for proper management.
Abstract: A review of 25 adult patients with intussusception is reported. Intussusception in adults constituted 16.6% of 150 intussusception cases observed during 1956-1985. The underlying pathologic processes were identified in 23 patients (92%). Etiologically, adult intussusception could be categorized into four groups: (1) tumor-related (13 cases, 52%); (2) postoperative (nine cases, 36%); (3) miscellaneous--Meckel diverticulum (one case, 4%); and (4) idiopathic (two cases, 8%). The tumor-related intussusceptions were caused by benign tumors in five and malignant tumors in eight patients. Postoperative intussusceptions were related to various factors including suture lines, ostomy closure sites, adhesions, long intestinal tubes, bypassed intestinal segments, submucosal edema, abnormal bowel motility, electrolyte imbalance, and chronic dilatation of the bowel. The sites of involvement of intussusception were jejunogastric (one), jejunojejunal (seven), ileoileal (four), ileocolic (10), and colocolic (three patients). Four patients had synchronous multiple (ileoileal and jejunojejunal), four had compound (ileoilealcolic), and two had recurrent intussusceptions. When an intussusception is encountered in adults, an underlying pathologic process usually can and should be determined for proper management.
393 citations
Journal Article•
TL;DR: In a review of literature, it was found that the clinical features in these three cases closely paralleled those of other cases of adult intussusception reported in this country.
Abstract: Three cases of intussusception in adults were observed within a period of six months in a small general hospital. All the patients were over 65 years old and all were admitted to hospital with intermittent cramping abdominal pains. None appeared to be in acute distress. In all three, body temperature, pulse rate and hemogram were within normal limits. Diagnosis was made preoperatively after barium enema studies. Bowel resection with end-to-end anastomosis was done in all three cases, in two because of gangrenous bowel. The site of intussusception was jejunojejunal in one case, ileocecal in another and colorectal in the third; and the cause in all cases was tumor, benign in two cases, malignant in one. The patients recovered uneventfully except for incisional abscess and diarrhea of seven days' duration in one. In a review of literature it was found that the clinical features in these three cases closely paralleled those of other cases of adult intussusception reported in this country.
272 citations
"Midgut pain due to an intussuscepti..." refers background in this paper
...This is contrary to intussusception in the pediatric population where an organic lesion is found in only 10% of documented cases [3]....
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...Major presenting features are intestinal obstruction and hemorrhage [3]....
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TL;DR: The experience supports earlier reports that US and CT are effective tools in the diagnosis of bowel lipoma and performs laparoscopic partial resection of the ileum, including the tumor.
Abstract: A 63-year-old woman was admitted to our hospital for investigation of upper abdominal pain and vomiting. Ultrasonography (US) showed a hyperechoic mass in the right lower abdomen, and computed tomography (CT) showed a low-density mass and intestinal invagination. Thus, we made a diagnosis of intestinal lipoma with intussusception and performed laparoscopic partial resection of the ileum, including the tumor. The resected specimen contained a round tumor, 25 × 22 × 20 mm, which was identified as an intestinal lipoma histopathologically. Our experience supports earlier reports that US and CT are effective tools in the diagnosis of bowel lipoma. Laparoscopic surgery is the treatment of choice for benign tumors of the small intestine because it is minimally invasive, with cosmetic, physical, and economic benefits.
41 citations
"Midgut pain due to an intussuscepti..." refers background in this paper
...The ileum (’intussusceptum’) telescopes into the colon (’intussuscipiens’) through the ileocaecal valve [5,6]....
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...Elective laparoscopic resection of lipomas is the treatment of choice with the concomitant benefits of laparoscopic surgery, such as shorter duration of hospital stay, less postoperative pain, early restoration of (GI) function and good cosmesis [6]....
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...The type of resection and anastomosis depends on the location, bowel wall integrity, and vascular supply of the lipoma [6]....
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Journal Article•
TL;DR: Adult intussusception remains a rare cause of abdominal pain and the treatment almost always is surgical.
Abstract: Background: Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30–1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. Methods: The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. Results: All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy (lymphoma) as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis (2-3 weeks prior) was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. “Target lesion” and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. Conclusion: Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical. Key words: Adult Intussusception
40 citations
"Midgut pain due to an intussuscepti..." refers background in this paper
...There is a theoretical risk of sarcomatous change but this has rarely been documented in the literature [1]....
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...Neoplasms of the small intestines are rare [1]....
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