Article

Ileocecal Valve Lipoma With Refractory Hemorrhage

Departments of Surgery and Public Health, Weill Cornell Medical College, New York, New York, USA.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons (Impact Factor: 0.91). 04/2009; 13(1):80-3.
Source: PubMed

ABSTRACT

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

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    • "Franc-Law et al. [13] reported that the appearance of dramatic symptoms in colonic lipomas probably depends on the size of tumors and their position in the large intestine, and that larger tumors and rarer left-sided colonic lipomas are more likely to cause acute obstruction. For large lipomas surgical resection is recommended to relieve symptoms or exclude malignancy [1, 8, 14], with a wide range of operative techniques, such as colotomy and excision, segmental colonic resection, hemicolectomy or subtotal colectomy, including laparoscopic procedures [2, 4, 5, 6,891011 14]. While colotomy with excision of the tumor and laparoscopic approaches should be considered for uncomplicated preoperatively diagnosed lipomas , more extensive operations should be performed in patients with questionable diagnosis and acute clinical symptoms [14]. "
    [Show abstract] [Hide abstract] ABSTRACT: Colonic lipomas are relatively common but they rarely progress to complete acute obstruction. We report a case of a 67-year-old woman with acute intestinal obstruction caused by a large pedunculated lipoma of the ileocecal valve. Preoperatively, the patient presented acutely with clinical and radiographic signs of small intestine ileus. A right hemicolectomy with subsequent terminolateral ileocolostomy was performed.The histopathological examination revealed a benign lipoma of the ileocecal valve which telescoped into the cecum and caused ileocolonic intussusception. The postoperative course was uneventful and the patient was free of symptoms during a 12-month follow-up period. Since these benign tumors are frequently revealed by laparotomy and the definitive diagnosis is made on the basis of histopathological examination, we can conclude that extensive resections of the large intestine are justified in cases with acute clinical presentation.
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    [Show abstract] [Hide abstract] ABSTRACT: Intussusception in adults accounts for less than 5% of all intussusceptions. It occurs when a segment of intestine invaginates into itself. PRESENTATION OF A CASE: We report a case of ileocolic intussusception in an adult caused by a giant ileal lipoma. Intussusceptions can be classified as ileocolic, ileocecal, colo-colic and ileo-ileal. Most are due to neoplasms (60% malign and 24-40% benign). In the colon, the possibility of malignancy is higher than in small intestine. Lipomas are the most common benign mesenchymal intestinal tumors, accounting for less than 5% of all gastrointestinal tumors. They are more frequent in colon than small intestine. Small lipomas (less than 2cm) are usually asymptomatic. Larger lesions may produce symptoms such as abdominal pain, obstruction or intussusception. Lipomas can be diagnosed with endoscopy, capsule endoscopy, barium enemas, CT and US. Intussusceptions in adults is a rare condition, most of them are caused by a malign neoplasms followed by benign neoplasms. US and CT are useful for diagnosis. Surgery is mandatory.
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