Small bowel volvulus due to a large intestinal lipoma: A rare case report

Abstract

Introduction: A lipoma of the small bowel mesentery is a uncommon clinical entity. It rarely causes obstruction and volvulus of the small bowel.

Case report: A 63 year old man was admitted to the emergency department with acute abdominal pain. Contrast-enhanced CT abdominal scan revealed small bowel obstruction due to a large fat density lesion suspected to be a lipoma. We performed a laparotomy in urgent setting that confirmed a small bowel volvulus secondary to a large antimesenteric lipoma. En-bloc resection with antiperistaltic side-to-side ileal anastomosis was done.

Discussion: Mesenteric lipoma is rare. They are usually asymptomatic but when have large sizes can cause several symptoms related to small bowel obstruction or volvulus. The diagnosis is difficult and is rarely made prior to exploratory laparoscopy or laparotomy. CT scan is the gold-standard imaging technique. It can shows the typical characteristics of tumor and may demonstrate the typical "vortex" pattern of a volvulus. In patients with acute clinical presentation en-bloc resection of the lipoma with the affected small bowel loops is often necessary. This treatment may also be reserved in asymptomatic patients with large mesenteric lipomas to avoid future complications.

Conclusion: Volvulus of the small bowel caused by an antimesenteric lipoma is a very rare entity. It is diagnosed by CT scan and surgery represents the standard treatment.

Keywords: Antimesenteric lipoma; Emergency surgery; Intestinal volvulus; Small bowel obstruction.

Fig. 1

Contrast-enhanced CT abdominal scan showed a dilated intestine with some air–fluid interfaces and ileal lipomatous mass envolving the transition loop.