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

Abstract

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.

Giant Mesenteric Lipoma in an Adult

“…In his case, the clinical scenario, evaluation, and subsequent management match the standard recommendations from other case reports in the literature. In a systematic review 15 of symptomatic small bowel lipomas (n = 147), abdominal pain was the most common presenting symptom (68.7%) followed by nausea or vomiting (35.3%) and hematochezia or gastrointestinal bleeding (33%). Among all small bowel lipomas, mesenteric location accounted for only 4.8% of cases.…”

Jejunal intussusception due to an atypical lipomatous tumor: a rare case report

“…In the small bowel, neoplasia is also the leading cause (57%), but malignancy is less frequent (30%). Adenocarcinoma is the most common malignant lesion in the colon, whereas metastatic melanoma accounts for most of the malignant causes in the small bowel [ 1 ]. Rarely, adenocarcinoma, lymphoma and leiomyosarcoma have been reported to be the leading point of small bowel intussusception [ 2 ].…”

“…The most common benign lesions acting as lead points of intussusceptions are polyps, adenomatous in colon or Peutz-Jeghers in the small bowel and lipomas. Gastrointestinal lipomas are most frequently found in patients aged 50–70 years [ 1 , 10 ]. Lipomas of the gastrointestinal tract are encountered with decreasing order of frequency in the colon (65–75%), small intestine (20–25%), stomach and esophagus [ 11 ].…”

“…Intussusception is defined as the prolapse of one bowel segment (intussusceptum) into an adjacent part (intussuscipiens; [ 1 , 2 ]). The incidence of adult intussusception stands at 2–3 cases/million/year and is responsible for ~1–2% of all adult intestinal obstructions [ 1 , 3 ].…”

“…The incidence of intestinal lipomas ranges from 0.035 to 4.4% [ 2 , 5 ]. Lipomas can arise throughout the gastrointestinal tract, with the small bowel accounting for 25%, and most commonly, they are encountered incidentally since they are usually asymptomatic [ 1 ]. However, obstruction, perforation, intussusception, pain and bleeding can complicate their presence.…”