Single-incision laparoscopic approach to ileal lipoma

Masami Maeda, MD, Yuji Nishizawa, PhD, Takayuki Fujii, MD, Akihiro Kondo, MD, Masao Fujiwara, PhD, Keiichi Okano, PhD, Yasuyuki Suzuki, PhD. Department of Gastroenterological Surgery, Kagawa University, Japan.

INTRODUCTION

Some minimally invasive techniques have been introduced in order to decrease morbidities related to standard laparoscopic procedures. Meanwhile, recent advances in small bowel endoscopy have facilitated the accurate diagnosis of small bowel diseases. We herein report a case that underwent single-incision laparoscopic surgery (SILS) for ileal lipoma after marking of the lesion site by double-balloon endoscopy (DBE).

PRESENTATION OF THE CASE

A 69-year-old man underwent esophagogastroduodenoscopy and colonoscopy for melena, but no causative lesion could be identified. We then performed videocapsule endoscopy (VCE), which revealed a submucosal tumor in the small bowel. Subsequently, DBE showed a submucosal tumor (4-cm in diameter) at the ileum, and an ink mark was placed near the tumor. Contrast-enhanced CT revealed a poorly enhanced tumor (36mm×15mm) in the ileum. PET/CT scan was performed, but no abnormal radioactivity was detected. To eliminate the substantial risk of intussusception caused by the tumor, we performed partial resection of the ileum using the SILS approach. In this case, the tumor site was easily detectable in an aid of the marking visible through the serosa and partial ileal resection was completed extraabdominally through the single incision. The histopathological diagnosis was lipoma of the ileum.

CONCLUSION

We were able to perform less invasive surgery by preoperative marking of the lesion site with VCE and DBE.

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