Lindsay Tse, DO, Elizabeth Verrico, DO, Maurizio Miglietta, DO. HUMC Palisades
Lipomas of the gastrointestinal tract are rare benign soft tissue tumors that are often discovered incidentally. These lesions are often asymptomatic, but have occasionally been reported to have clinical significance as will be described in this case report. A 40 year old male initially presented to his primary care physician’s office with a three week history of vague intermittent abdominal pain. His pain was located in the mid epigastrium and was associated with mild nausea. Past medical history was significant for hyperlipidemia and a right- sided goiter, and he denied any previous surgeries. Outpatient work up revealed a microcytic anemia, intermittent melena and hemoccult positive stools. The patient was referred to hematology and gastroenterology. Endoscopies revealed gastritis, and small internal and external hemorrhoids. He underwent an outpatient CT scan which demonstrated a 6.0 x 2.3cm mass within the lumen of the jejunum causing long segment non-obstucting intussusception. Subsequently, the patient was referred to surgery and underwent a diagnostic laparoscopy. At the time of surgery, an approximately twelve centimeter segment of proximal jejunum was identified intussuscepting into a distal limb. This segment was attempted to be reduced laparoscopically, however there was significant mesentery within in the intussusceptum and the segment could not be safely reduced. Therefore, the section of bowel was delivered through a small periumbilical incision. The intussusceptum was then able to be manually reduced from the intussusception. At this point a large mass was palpated inside the lumen of the jejunum. A small bowel side to side, functional end to end resection and anastomosis was preformed. The bowel was returned to the abdomen and the abdomen was re-insufflated. The remainder of the small bowel was run and no additional lesions were identified. Final pathology revealed a 5.5 x 3.6 x 3.5 cm submucosal partially obstructing lipoma with ulceration at the tip. The patient recovered uneventfully and was discharged home on the second post operative day. This case report describes a submucosal jejunal lipoma that was acting as a lead point for intermittent non-obstructing small bowel intussusception, while simultaneously causing a microcytic anemia due to ulceration at the tip of the lipoma. Laparoscopic assisted reduction and small bowel resection is a safe and effective treatment for gastrointestinal tract lipomas that are unable to removed endoscopically.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88169
Program Number: P185
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster