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

Abstract

IntroductionAdult 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 PresentationA 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.ConclusionA 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.

A 58-Year-Old Woman with Acute Torsion of the Small Bowel Due to Diffuse Intestinal Lipomatosis

“…The main characteristic of small intestinal lipomatosis is a homogenous, diffuse intramural region of hypodensity. While lipomas are present as asymmetrical masses, small bowel lipomatosis appears as a widespread adipose tissue infiltration into the submucosa [ 25 , 26 ]. The fatty infiltration in small intestinal lipomatosis is ill-defined and unencapsulated, allowing for easy differentiation between the 2 conditions.…”

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

“…Lipomas are soft in texture, and their shape can change in response to intestinal movement and compression ( 1 , 3 ). Therefore, it was not surprising that our study found no significant difference in lipoma shape between the 2 groups.…”

“…Lipomas are benign tumors that can occur in all organs. They often occur in subcutaneous tissue and less frequently in the gastrointestinal tract, accounting for only 5% of all gastrointestinal tract tumors ( 1 - 3 ). Gastrointestinal lipomas were first described by Bauer et al in 1757 ( 3 - 6 ).…”