Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 4  |  Page : 525-527  

Lipoma of small intestine


Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication14-Jul-2015

Correspondence Address:
Pradhan M Pagaro
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.160826

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  Abstract 

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

How to cite this URL:
Pagaro PM, Deshpande A. Lipoma of small intestine. Med J DY Patil Univ [serial online] 2015 [cited 2019 May 19];8:525-7. Available from: http://www.mjdrdypu.org/text.asp?2015/8/4/525/160826


  Introduction Top


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. [1] 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 Top


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.
Figure 1: Submucosal small intestinal lipoma

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Figure 2: Submucosal lipoma of small intestine

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Figure 3: Submucosal lipoma

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Figure 4: Sheets of fat cells within the mucosal layers

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Figure 5: Lipoma seen in between the muscle layers and below muscle

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Figure 6: Lipoma infiltrating the muscle fibres (high Power ×40)

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  Discussion Top


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 [1] 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. [2] has reported a case of simultaneous diverticulosis, lipomatosis and volvulus of the small intestine.

Bodos et al. [3] 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. [4] reported a case of colonic lipoma in a 54-year-old causing intussusceptions. Mouaqit et al. [5] have reported a 55-year-old with pedunculated lipoma in the colon causing intussusceptions. Mona it et al. [6] 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. [7] also reported a 78-year-old female having submucosal lipoma of the small intestine causing intussusceptions. Ham et al. [8] reported a 60-year-old male with rapidly progressing intestinal obstruction. Hemicolectomy revealed a colonic lipoma. Ramdass et al. [9] 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. [10] reported a case of giant intramural lipoma (>4 cm) in descending colon causing intussusceptions. Similarly Dhar et al. [11] reported an interesting case of submucosal lipoma of the small intestine. Finally Kshirsagar et al. [12] 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 Top


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.

 
  References Top

1.
Climie AR, Wylin RF. Small-intestinal lipomatosis. Arch Pathol Lab Med 1981;105:40-2.  Back to cited text no. 1
[PUBMED]    
2.
Neilson D, Wilkinson N, Magell J. Case of simultaneous diverticulosis, lipomatosis and volvulus of the small intestine. Br J Surg 1990;77:105.  Back to cited text no. 2
    
3.
Bodos A, Rivilla F, Maluenda C. A 10 year old girl of multiple lipomatosis of small and large intestine. Eur J Paediatr 2008;5:601.  Back to cited text no. 3
    
4.
Philips LJ 2 nd , Svahn JD. Colonic lipoma. A rare cause of adult intussusception. World J Colorectal Surg 2013;3:19. Available from: http://www.services.bepress.com/wjcs/vol3/iss2/art19/. [Last accessed on 2014 Nov 14].  Back to cited text no. 4
    
5.
Mouaqit O, Hasnai H, Chbani L, Oussaden A, Maazaz K, Amarti A, et al. Pedunculated lipoma causing colo-colonic intussusception: A rare case report. BMC Surg 2013;13:51.  Back to cited text no. 5
    
6.
Mouaqit O, Hasnai H, Chbani L, Benjelloun B, Bouhaddouti HE, Majdoub KI, et al. Adult intussusceptions caused by a lipoma in the jejunum: Report of a case and review of the literature. Med J DY Patil Univ 2015;8. Available from: http://www.wjes.org/content/7/1/28. [Last accessed on 2014 Nov 14].  Back to cited text no. 6
    
7.
Nincheri Kunz M, Evaristi L, Spadoni R, Cozzani R, Valle O, Bacigalupo B. Lipoma of the small intestine as a rare cause of intestinal occlusion. Minerva Chir 1994;49:859-65.  Back to cited text no. 7
    
8.
Ham JJ, Heiner JD, Gower LE, Litner JS. Abdominal pain caused by intestinal lipoma. West J Emerg Med 2010;11:114.  Back to cited text no. 8
    
9.
Ramdass MJ, Mathur S, Seetahal-Maraj P, Barrow S. Gastric lipoma presenting with massive upper gastrointestinal bleeding. Case Rep Emerg Med 2013;2013:506101.  Back to cited text no. 9
    
10.
Mitra A, Agarwal PN, Singh R, Dutt K, Kumari M, Meena M. Giant intramural lipoma causing colonic intussusceptions with multiple jejunal intussusceptions - A case report. Transl Gastrointest Cancer 2013;2:1. Available from: http://www.amepc.org/tgc/article/view/1299/1882. [Last accessed on 2014 Nov 14].  Back to cited text no. 10
    
11.
Dhar R, Sahu S, Roychoudhry AK. An interesting intestinal lipoma case. Int J Sci Res 2014;3:3. Available from: http://www.theglobaljournals.com/ijsr/file.php?val=March_2014_1394097093_98fb6_140%20Dr.%20Arnav%20Kr.%20Roychoudhury.pdf. [Last accessed on 2014 Nov 14].  Back to cited text no. 11
    
12.
Kshirsagar AY, Nangare NR, Gupta V, Vekariya MA, Patankar R, Mahna A, et al. Multiple giant intra abdominal lipomas: A rare presentation. Int J Surg Case Rep 2014;5:399-402.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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