|Year : 2015 | Volume
| Issue : 4 | Page : 525-527
Lipoma of small intestine
Pradhan M Pagaro, Anjali Deshpande
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Web Publication||14-Jul-2015|
Pradhan M Pagaro
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Lipomas of the gastrointestinal tract (GIT) are rare. They are usually submucosal, but rarely involve the muscle layer or serosa. Most ot submucosal lipomas of GIT are present in the colon (65-75%), small intestine (25%) and rarely in stomach or jejunum. These lesions are usually asymptomatic and rarely are incidentally found in autopsies. During lifetime, they are detected when they cause intussusceptions and obstructive symptoms. These lesions can also rarely become ulcerated causing symptoms that come to notice. The present case report is of submucous lipoma in the terminal ileum. A 45-year-old female came complaining of pain in the abdomen, gradually increasing over a period of 4 days. Computerized tomography scan revealed a mass in the submucosa. She was operated, and histopathology examination confirmed the mass as lipoma in the submucosa as well as within the muscle layer of the small intestine.
Keywords: Intestinal lipoma, intussusceptions, obstruction
|How to cite this article:|
Pagaro PM, Deshpande A. Lipoma of small intestine. Med J DY Patil Univ 2015;8:525-7
| Introduction|| |
Lipomas of the gastrointestinal tract (GIT) are rare. They are usually asymptomatic. They occur in the age group of 50-60 years but rarely can occur at a younger age, and even more rarely in children.  They usually do not cause symptoms but only come to notice when they cause intussusceptions which are common in such cases leading to symptoms of obstruction like pain and distension of abdomen and vomiting. Computerized tomography (CT) scan or magnetic resonance imaging (MRI) usually confirms the diagnosis of intestinal lipomas. They commonly occur in the large intestine but rarely in small intestine and stomach. Rarely the GIT lipomas are multiple involving many areas of small and large intestine causing multiple areas of volvulus or intussusceptions. Lipomas involving mesentry, which can cause obstruction, are very rare, and only 30 such cases have been documented in the literature.
| Case Report|| |
A 45-year-old female came with pain in abdomen gradually increasing over a period of 4 days. The pain was severe when she reported to the hospital. She also gave a history of nausea and vomiting after every meal. There was no history of fever. On examination, there was mild distension of the abdomen with everted umbilicus that on palpation showed mild guarding and rigidity. Investigations including complete blood count, haemotocrit and other routine laboratory investigations were within normal limits. The CT scan detected a mass in the submucosa of the small intestine, a little short of the ileocaecal valve. The patient was operated, and a thickened area, and a stricture were noted in the wall of the small intestine. No gross mass was seen. A specimen of resected bowel 8 cm × 2.5 cm × 2 cm was received in the pathology department.
Sections from the lesion confirmed the diagnosis of submucosal lipoma that had also infiltrated the muscle layer [Figure 1] [Figure 2] [Figure 3] [Figure 4] [Figure 5] [Figure 6]. The sheets of benign fat cells were seen within the folds of mucosa, submucosa, below the muscle layer and also in between the muscle layers of the small intestine. Such occurrence involving the muscle layer of the small intestine is very rare.
| Discussion|| |
Submucosal lipomas of the small intestine are rare, and lipomas involving the muscle layer are still rarer. GIT lipomas are benign tumors composed of mature adipose tissue, are located mainly in the colon, intestine and jejunum, are usually asymptomatic. They are usually in the submucosa and rarely in muscle or subserosal layers. The incidence of large bowel lipoma described by Bauer in 1757 is 0.2-4.4%. CT scan an identify lipomas conclusively due to the density of fat.
They are usually asymptomatic and are diagnosed incidentally in autopsies. They come to notice during a lifetime when they cause symptoms due to intussusceptions that were reported first by Barbettee. This complication is more common in children but rarely can occur in young adults or middle age.
Climie and Wylin  has reported and described two cases of small intestinal lipomatosis associated with intussusceptions. A review made by him reports 16 cases of intestinal lipomas. Neilson et al.  has reported a case of simultaneous diverticulosis, lipomatosis and volvulus of the small intestine.
Bodos et al.  reported a case of multiple lipomatosis involving small and large intestine in a 10-year-old girl causing obstructive symptoms. Philips and Svahn et al.  reported a case of colonic lipoma in a 54-year-old causing intussusceptions. Mouaqit et al.  have reported a 55-year-old with pedunculated lipoma in the colon causing intussusceptions. Mona it et al.  have also described a jejunal lipoma in a 35-year-old causing jejunal intussusceptions. The lipoma was also seen in muscle layers. Kunz et al.  also reported a 78-year-old female having submucosal lipoma of the small intestine causing intussusceptions. Ham et al.  reported a 60-year-old male with rapidly progressing intestinal obstruction. Hemicolectomy revealed a colonic lipoma. Ramdass et al.  reported a 37-year-old case of gastric lipoma presenting with massive GIT bleeding. MRI revealed a submucous mass with was confirmed as submucosal lipoma on histopathology.
Mitra et al.  reported a case of giant intramural lipoma (>4 cm) in descending colon causing intussusceptions. Similarly Dhar et al.  reported an interesting case of submucosal lipoma of the small intestine. Finally Kshirsagar et al.  reported multiple intraabdominal lipomas detected by MRI involving mesentry in a 60-year-old presenting with signs of intestinal obstruction. According to them only 30 mesentric intraabdominal lipomas have been documented in the literature.
| Conclusion|| |
Though rare, intestinal lipomas can cause symptoms of intestinal obstruction. Therefore, such tumors should be considered clinically in the differential diagnosis of cases of acute abdomen due to intussusceptions or intestinal obstruction. MRI and CT scan helps in diagnosing these tumors due to the fat content.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]