Adult intussusceptions caused by a lipoma in the jejunum: report of a case and review of the literature

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

Background

Intestinal lipoma is considered the most common benign tumor that causes intussusception. This retrospective case-control study aimed to present the clinical and multidetector computed tomography (MDCT) features between intestinal lipomas with and without intussusception and examine risk factors that predict intussusception caused by intestinal lipomas.

Methods

We retrospectively analyzed 281 adult patients diagnosed with intestinal lipoma by radiologists using whole-abdominal MDCT between January 2015 and August 2022. Patients were divided into adult intussusception (AI) and non-AI groups based on MDCT images. Univariate logistic regression was performed to identify risk factors for intestinal lipoma-induced intussusception.

Results

A total of 281 patients with intestinal lipomas were included in the study, with an average age of 68.0±11.3 years, and the male to female ratio was about 1:1.4. Among them, 24 patients developed lipoma-induced intussusception. Patients in the AI group presented with more abdominal pain (70.8% vs. 47.1%, P=0.03), nausea/vomiting (37.5% vs. 14.8%, P=0.009), hematochezia/melena (29.2% vs. 11.3%, P=0.02), and abdominal tenderness (66.7% vs. 24.9%, P<0.001). Lipomas were more common in the small bowel (224/281, 79.7%) than the large bowel (57/281, 20.3%). Lipomas in the AI group showed more heterogeneous hypodensity (41.7% vs. 15.6%, P=0.004), longer length (median, 2.2 vs. 1.2 cm, P<0.001), and larger volume (median, 4.1 vs. 0.6 cm3, P<0.001). In the univariate logistic regression, lipoma density [odds ratio (OR) =3.875, 95% confidence interval (CI): 1.609-9.331, P=0.003] and lipoma length (OR =3.216, 95% CI: 1.977-5.231, P<0.001) were risk factors for intestinal lipoma-induced intussusception.

Conclusions

More patients in the AI group have digestive tract symptoms than those in the non-AI group. Lipoma density and length are risk factors for intussusception in patients with intestinal lipoma. In addition, the common site of intestinal lipoma may have changed from the colon to the small intestine.

Small intestinal obstruction due to subserosa fibrolipoma in a 2-year-old child: A case report and literature review

Lipomas of the gastrointestinal tract (GIT) are generally rare. They are rare in children, and when they occur they are usually submucosa. Most of the submucosa lipomas of GIT are present in the colon (65%-75%) and small intestine (25%). In children, intestinal lipoma is a documented cause of pathological lead point intussusception, especially when located in the submucosa. The present case report is of subserosa lipoma in the distal ileum. A 2-year-old boy presented with features of intestinal obstruction which was preceded by a painless abdominal mass. In the absence of computerised tomography scan, he was operated, and histopathology examination confirmed the mass as pedunculated fibrolipoma arising from the subserosa and causing extrinsic compression of the ileum.

Uncommon, overlooked and underreported causes of upper gastrointestinal bleeding

Upper gastrointestinal bleeding (UGB) is a potentially fatal consequence of digestive disorders. There is a wide range of rare causes for UGB that can lead to misdiagnosis and occasionally catastrophic outcomes. The lifestyles of those who are afflicted are mostly responsible for the underlying conditions that result in the hemorrhagic cases. The development of a novel approach targeted at raising public awareness of the issue and educating the public about it could significantly contribute to the elimination of gastrointestinal bleeding with no associated risks and to a nearly zero mortality rate. There are reports of UGB related to Sarcina ventriculi, gastric amyloidosis, jejunal lipoma, gastric schwannoma, hemobilia, esophageal varices, esophageal necrosis, aortoenteric fistula, homosuccus pancreaticus, and gastric trichbezoar in the literature. The common feature of these rare causes of UGB is that the diagnosis is difficult to establish before surgery. Fortunately, UGB with a clear lesion in the stomach itself is a clear sign for surgical intervention, and the diagnosis can only be verified by pathological examination with the help of immunohistochemical detection of a particular antigen for a specific condition. The clinical traits, diagnostic techniques, and the therapeutic, or surgical options of unusual causes of UGB reported in the literature are compiled in this review.

Ileocolic intussusception due to intestinal lipoma in an adult patient

Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.

Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report

BACKGROUND

Intestinal lipomas are rare benign gastrointestinal (GI) tumors, usually asymptomatic, but may become symptomatic as the result of some complications such as intussusception, intestinal obstruction, volvulus or bleeding. They can occur at any site along the entire GI tract, more frequent in colon and rarely in small intestine. The patient reported here is a very rare case of jejunal lipoma, ulcerated and intussuscepted, diagnosed in an adult investigated for a chronic iron deficiency anemia (IDA), and successfully managed by segmental jejunal resection.

CASE SUMMARY

A 63-year-old male was referred to “St. Spiridon” Hospital, Institute of Gastroenterology and Hepatology, Iasi, to investigate an obscure GI bleeding with an IDA. After upper GI endoscopy and colonoscopy were performed, excluding potentially bleeding lesions, videocapsule endoscopy was then carried out, revealing fresh blood and a protruding lesion in proximal jejunum, findings confirmed by a single-balloon enteroscopy. Multiple biopsies were taken from the lesion, but histological results were inconclusive. Then, contrast - enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density, suggestive for lipoma. A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected en bloc, and sent for further histopathologic analysis. The patient made an uneventful recovery and was discharged seven days later, and at six months follow-up he had no complains and his hemoglobin returned to normal value.

CONCLUSION

Lipomas are very rarely located in the jejunum, usually asymptomatic, but they may lead to complications such as intussusception and bleeding. Surgical resection remains the treatment of choice.

Jejunal intussusception in an adult due to multiple lipomas: a rare case report from Syria

Intussusception in adulthood is an uncommon medical condition. Multiple lipomas are a very rare cause of intussusception, and the jejunum is the least common location of lipoma. We report an unusual case of a 37-year-old man presented with non-specific symptoms. Computed tomography of the abdomen revealed a proximal jejunal loop distention. Laparoscopy revealed a jejunal intussusception 40 cm distal to treitz ligament. We switched to open surgery after failure of laparoscopic reduction which showed multiple lipomas as the cause of the intussusception. We resected a segment of 35 cm and reanastomosed the bowel. Three days later, the patient was discharged with uneventful recovery.

Complete small bowel obstruction without intussusception due to a submucosal lipoma

Submucosal lipomas of the small bowel are rare, often asymptomatic, benign tumors. Large lesions may present with acute symptoms such as a bowel obstruction from an intussusception or acute hemorrhage. Acute findings such as these require operative intervention. In this case, we present a 53-year-old female with a complete small bowel obstruction secondary to a submucosal lipoma without signs of an intussusception.

Subtle presentation of jejunal lipomata with intussusception in a young adult

Lipomas of gastrointestinal (GI) tract could occur at any anatomical level and represent 1–2% of all GI tumours. Amongst them, <2% are noted in jejunum and almost all in later decade of life with varied and non-specific symptoms. Their intussusception is even rarer and mostly present with full obstructive symptoms. Herein, we would like to report a successfully treated case of subtle jejunal lipomata with intussusception in an otherwise healthy a 21-year-old female.

Rare case of adult jejunojejunal intussusception secondary to angiolipoma

A woman in her mid-50s presented with a 3-month history of upper abdominal pain. Initial examination using ultrasound was unremarkable and the patient was sent home. The patient returned 8 days later and CT imaging revealed intussusception as the cause of her symptoms. The involved bowel was surgically reduced and transected with the lead point found to contain a 3 cm mass. Histological examination revealed the mass to be an angiolipoma. To the best of our knowledge, this is the first reported case of adult jejunojejunal intussusception secondary to angiolipoma.

Jejunojejunal intussusception secondary to submucosal lipoma resulting in a 5-year history of intermittent abdominal pain

Jejunal lipomata are an unusual cause of adult intussusception. We report a case of a 44-year-old Chinese woman who presented with a 3-day history of abdominal pain and nausea; she had a 5-year history of similar episodic symptoms after meals. Contrast-enhanced CT revealed a fat-density lead point in the jejunum resulting in intussusception. Single port laparoscopic surgery was performed with reduction of the intussusception, bowel resection and primary anastamosis. Histology confirmed a benign submucosal lipoma. We discuss the recent published literature on this rare entity and show CT images and intraoperative pictures.

Large benign submucosal lipoma presented with descending colonic intussusception in an adult

Patient: Female, 34

Final Diagnosis: Lipoma of the large intestine

Symptoms: Abdominal pain • bloating • blood in stool • constipation • lose of appetite • nausea

Medication: —

Clinical Procedure: —

Specialty: Surgery