Ileocecal valve lipoma with refractory hemorrhage

Abstract

Background: Lipomas are the most common benign mesenchymal tumors of the gastrointestinal tract, with the colon being the most prevalent site. Intestinal lipomas are usually asymptomatic. Tumors >2 cm in diameter may occasionally cause nonspecific symptoms, including change in bowel habits, abdominal pain, or rectal bleeding, but with resection the prognosis is excellent. Herein, we describe the case of an elderly male who presented with painless hematochezia.

Methods: Both colonoscopy and computed tomography of the abdomen and pelvis confirmed the presence of a mass near the ileocecal valve. Because of continuing bleeding, the patient required laparoscopic-assisted right hemicolectomy to resect the mass.

Results: Both gross and microscopic pathology were consistent with lipoma at the ileocecal valve.

Conclusion: Previous cases of ileocecal valve lipomas have been reported in the English literature, with the majority presenting as intussusception or volvulus. We present a rare case of an ulcerated ileocecal valve lipoma presenting as lower gastrointestinal bleeding that was treated successfully with laparoscopic resection.

Figure 1.

CT image of mass preoperatively, demonstrating a 1.9-cm × 1.5-cm lesion within the cecum (arrow), measuring -80 Hounsfield units, consistent with adipose tissue.

Figure 2.

Intraoperative photograph with cecum opened to reveal a 3.5-cm × 2.0-cm × 1.5-cm tumor (bottom arrow) and ileocecal valve (top arrow).

Figure 3.

Histopathology of lipoma: Hematoxylin and eosin stain (20× magnification) reveals a circumscribed collection of mature adipocytes.