Small Bowel Obstruction due to Intestinal Xanthomatosis

Abstract

Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

Non-gastric Gastrointestinal Xanthomas: Case Series and Literature Review

“…They are usually solitary lesions, but multifocal cases have been reported [13]. First described by Shafer in 1971 [1,5], only four esophageal cases have been reported [11]. Two of them occurred in patients who underwent thoracic radiotherapy for systemic non-Hodgkin lymphoma and squamous carcinoma of the tracheal carina.…”

“…Intestinal xanthomatosis is a non-neoplastic diffuse lesion that can lead to obstruction and can present as a mass-like lesion mimicking malignant tumor obstruction due to prominent fibrosis and inflammation. It occasionally involves several compartments of the gastrointestinal tract [17], and it is not associated with predisposing conditions such as hyperlipidemia or lymphoproliferative lesions [5].…”

“…Originally termed "lipoidinseln", more recently these lesions are named xanthelasma or xanthoma [3,4]. They are commonly seen in patients with dyslipidemia or other conditions such as previous chemotherapy, radiotherapy, and infection [disseminated mycobacterium avium intracellulare (MAI) and cytomegalovirus (CMV) colitis] in immunosuppressed patients (AIDS) [5]. Gastric xanthomas arise in the pathologic gastric mucosa (chronic gastritis, intestinal metaplasia, atrophic gastritis, gastric ulcer and changes due to excess bile reflux).…”

“…The reported incidence is quite variable (0.018%-0.8%) in the endoscopy series, but reached 58% in an autopsy series [4]. The incidence is higher in elderly patients [5,6].…”

“…The clinical picture together with the past medical history, symptoms of storage diseases, AIDS and/or macroglobulinemia, is essential. In addition, special stains such as Gram, Ziehl-Neelsen, Gomori methenamine silver, PAS and PAS-Diastase and immunohistochemistry for cytokeratin AE1-AE3 can be helpful [5].…”