Radiological manifestations of benign mesenteric lipoma that presented with acute intestinal obstruction: A case report

Abstract Background Intestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies. Case presentation We report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well. Conclusions Patients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation.

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Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/2576280 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Gerald Okanandu Udigwe ◽

George Uchenna Eleje ◽

Eric Chukwudi Ihekwoaba ◽

Onyebuchi Izuchukwu Udegbunam ◽

Richard Obinwanne Egeonu ◽

...

Keyword(s):

Intestinal Obstruction ◽

Exploratory Laparotomy ◽

Acute Intestinal Obstruction ◽

University Teaching ◽

Successful Outcome ◽

Management Approach ◽

Abdominal Pregnancy ◽

Case Presentation ◽

X Ray ◽

Female Baby

Background. Acute intestinal obstruction during pregnancy is a very challenging and unusual nonobstetric surgical entity often linked with considerable fetomaternal morbidity and mortality. When it is synchronous with abdominal pregnancy, it is even rarer.Case Presentation. A 28-year-old lady in her second pregnancy was referred to Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, at 27 weeks of gestation due to vomiting, constipation, and abdominal pain. Examination and ultrasound scan revealed a single live intra-abdominal extrauterine fetus. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was successful till the 34-week gestational age when she had exploratory laparotomy. At surgery, the amniotic sac was intact and the placenta was found to be adherent to the gut. There was also a live female baby with birth weight of 2.3 kg and Apgar scores of 9 and 10 in the 1st and 5th minutes, respectively, with the baby having right clubbed foot. Adhesiolysis and right adnexectomy were done. The mother and her baby were well and were discharged home nine days postoperatively.Conclusion. To the best of our knowledge, this is the first report of abdominal pregnancy as the cause of acute intestinal obstruction in the published literature. Management approach is multidisciplinary.

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T-shaped Meckel’s diverticulum: a rare anatomical variant complicating small bowel volvulus

International Surgery Journal ◽

10.18203/2349-2902.isj20183218 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2929

Author(s):

Vergis Paul ◽

Ramu R. ◽

Kocheril Sheryl Mathews ◽

Ashly Thomas ◽

Reesha P. A. ◽

...

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Terminal Ileum ◽

Meckel’S Diverticulum ◽

Exploratory Laparotomy ◽

Meckel's Diverticulum ◽

Anatomical Variant ◽

Small Bowel Volvulus ◽

Common Presentation ◽

Congenital Diverticulum

The Meckel's diverticulum is a congenital diverticulum arising from the terminal ileum and is the unobliterated proximal portion of the vitellointestinal duct. Intestinal obstruction due to Meckel’s diverticulum is the most common presentation in adults and is the second most common presentation in children. We present a case of a 58-year-old gentleman presented with acute abdomen who was later found to have Giant T- shaped Meckel’s Diverticulum complicating small bowel volvulus on exploratory laparotomy. A T-shaped Meckel's diverticulum has not yet been described.

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Small bowel malignant tumor: a diagnostic dilemma, a case report and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20204692 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3785

Author(s):

Mahmood A. Makhdoomi ◽

Abdulaziz Almotlaq ◽

Nader A. Tawfiq

Keyword(s):

Case Report ◽

Small Bowel ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Diagnostic Dilemma ◽

Small Bowel Tumor ◽

Introduction History ◽

Abdominal Examination ◽

Bowel Dilatation ◽

Saudi Male

A 47 years old Saudi male was admitted to king Khalid hospital with complaints of constipation and abdominal distension. Abdominal examination showed as a case of intestinal obstruction. He was fully evaluated and was treated first conservatively, until all investigative study confirmed as huge small bowel dilatation (mainly jejunum). Exploratory laparotomy confirmed small bowel tumor and on histology an adenocarcinoma. The introduction, history and research paper will also be discussed in this report.

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Concurrent intestinal malrotation and Meckel's diverticulum presenting as acute intestinal obstruction in an adult

International Surgery Journal ◽

10.18203/2349-2902.isj20212288 ◽

2021 ◽

Vol 8 (6) ◽

pp. 1904

Author(s):

Aishwarya Emerald Manohar ◽

M. S. Kalyan Kumar ◽

V. Vijayalakshmi ◽

R. Kannan

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Intestinal Obstruction ◽

Meckel’S Diverticulum ◽

Postoperative Recovery ◽

Meckel's Diverticulum ◽

Intestinal Malrotation ◽

Emergency Laparotomy ◽

Meckel’S Diverticulitis ◽

Subacute Intestinal Obstruction

Intestinal malrotation is the partial or complete failure of rotation of midgut around the superior mesenteric artery, while Meckel’s diverticulum is the remnant of vitellointestinal duct and concurrence of these congenital abnormalities in an adult is considered a rarity. Till date only 3 cases of concurrent intestinal malrotation and Meckel's diverticulum have been reported. We report a 18 years male who presented with a 3 day history of abdominal pain, bilious vomiting, obstipation and chronic abdominal pain on and off since 3 years of age. During the last episode which occurred 1 year back, he was diagnosed with intestinal malrotation with subacute intestinal obstruction and was treated conservatively. Examination revealed the presence of signs of peritonitis. After resuscitation, CECT abdomen was taken which showed dilated small bowel loops in the subhepatic region associated with malrotation. Emergency laparotomy revealed a Ladd's band below which the gangrenous small bowel loops 150 cm from the duodenojejunal (flexure until 5 cm proximal to the ileocecal junction) were found herniating into the subhepatic region with a Meckel’s diverticulum and a right sided DJ flexure. We proceeded with the band release and resection of gangrenous bowel followed by proximal jejunostomy with distal ileostomy. HPE was consistent with Meckel’s diverticulitis without any ectopic gastric or pancreatic mucosa. Ostomy reversal was done after 8 weeks. Patient had an uneventful postoperative recovery during both the admissions and he is on regular follow-up now.

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Mesenteric lipoma: a rare cause of acute small bowel obstruction

International Surgery Journal ◽

10.18203/2349-2902.isj20214029 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3214

Author(s):

Debarghya Chattarjee ◽

Vijay Raina ◽

Rajeev Sharma

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Human Body ◽

Surgical Intervention ◽

Acute Intestinal Obstruction ◽

Abdominal Symptoms ◽

Clinical Literature ◽

Multiple Imaging ◽

Acute Small Bowel Obstruction ◽

Mesenteric Lipoma

Lipomas, also known as universal tumors, can be found almost anywhere in the human body. However mesenteric lipomas are rare entities, with less than 100 cases reported in clinical literature. Patients may present with chronic non-specific abdominal symptoms, or rarely acute intestinal obstruction. Multiple imaging modalities are available for pre-operative diagnosis. Surgical intervention is required for treatment of symptomatic mesenteric lipomas.

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Paroxysmal Nocturnal Hemoglobinuria: Diagnostic Challenges in Pediatric Patient

Case Reports in Pediatrics ◽

10.1155/2019/4930494 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Dharshana Krishnaprasadh ◽

Inna Kaminecki ◽

Anna Sechser Perl ◽

Jonathan Teitelbaum

Keyword(s):

Bone Marrow ◽

Small Bowel ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Bone Marrow Failure ◽

Exploratory Laparotomy ◽

Recurrent Abdominal Pain ◽

Histological Evaluation ◽

Small Vessel Vasculitis ◽

Wall Thickening ◽

Erythroid Hyperplasia

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening hematologic stem cell disorder characterized by hemoglobinuria, thrombosis, and tendency for bone marrow failure. The rare incidence of PNH in children, its nonspecific clinical presentation, and occasional absence of hemoglobinuria make the diagnosis challenging. We present a case of a 17-year-old boy who was hospitalized with a history of recurrent abdominal pain, fever, and dark-colored urine. Laboratory tests revealed anemia, thrombocytopenia, and elevated inflammatory markers. Urinalysis was positive for protein and red blood cells, too many to be counted. Complement studies were within normal limits. Abdominal computed tomography showed a segment of the small bowel with wall thickening and signs of possible microperforation. Exploratory laparotomy revealed necrosis of the small bowel, and histological evaluation was suggestive of an autoimmune process with small vessel vasculitis. Bone marrow biopsy showed hypocellular marrow with a decreased number of myeloid cells, normal number of megakaryocytes, and signs of erythroid hyperplasia. Flow cytometry detected deficiency of CD59 leading to the diagnosis of PNH. The patient was treated with eculizumab infusions resulting in significant improvement. This case highlights the need for high clinical suspicion for rare entities such as PNH in patients presenting without hemoglobinuria.

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Intestinal obstruction caused by mesenteric fat necrosis masquerading as small bowel malignancy

The Egyptian Journal of Surgery ◽

10.4103/ejs.ejs_65_17 ◽

2017 ◽

Vol 36 (4) ◽

pp. 460

Author(s):

IslamH Metwally ◽

SalehS Saleh ◽

IslamA Elzahaby ◽

AbdelhadiM Shebl

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Fat Necrosis ◽

Mesenteric Fat ◽

Small Bowel Malignancy

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An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2017/6962876 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

O. S. Balogun ◽

A. O. Osinowo ◽

M. O. Afolayan ◽

A. A. Adesanya

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Primary Closure ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Postoperative Recovery ◽

Elderly Female ◽

Insidious Onset

Small bowel obstruction secondary to phytobezoars is an unusual presentation in surgery. We present a case of an elderly female patient with an insidious onset of abdominal pain, abdominal distension, and bilious vomiting diagnosed radiologically to be small bowel obstruction. Exploratory laparotomy revealed a trapped mass of vegetable matter in the distal ileum. She had enterotomy with primary closure for removal of obstructing ileal phytobezoars. Her postoperative recovery was uneventful.

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Perforated Meckel’s Diverticulum Lithiasis: An Unusual Cause of Peritonitis

Case Reports in Surgery ◽

10.1155/2013/825628 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Umasankar Mathuram Thiyagarajan ◽

Amirthavarshini Ponnuswamy ◽

Atul Bagul ◽

Prabakar Ponnuswamy

Keyword(s):

Gastrointestinal Tract ◽

Small Bowel ◽

Intestinal Obstruction ◽

Acute Abdomen ◽

Congenital Malformation ◽

Healthy Individual ◽

Stone Formation ◽

Meckel’S Diverticulum ◽

Exploratory Laparotomy ◽

Meckel's Diverticulum

Meckel’s diverticulum is the commonest congenital malformation of gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, it can present as bleeding, perforation, intestinal obstruction, intussusception, and tumours. These complications, especially bleeding, tend to be more common in the paediatric group and intestinal obstruction in adults. Stone formation (lithiasis) in Meckel’s diverticulum is rare. We report a case of Meckel’s diverticulum lithiasis which presented as an acute abdomen in an otherwise healthy individual. The patient underwent an exploratory laparotomy which revealed a perforated Meckel’s diverticulum with lithiasis; a segmental resection with end-to-end anastomosis of small bowel was performed. Patient recovery was delayed due to pneumonia, discharged on day 20 with no further complications at 6 months following surgery.

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Phytobezoar causing intestinal obstruction in a neonate: A case report

Journal of Neonatal Surgery ◽

10.47338/jns.v10.704 ◽

2020 ◽

Vol 10 ◽

pp. 3

Author(s):

Ravi Patcharu ◽

Karunesh Chand ◽

Badal Parikh

Keyword(s):

Intestinal Obstruction ◽

Clinical Skill ◽

Exploratory Laparotomy ◽

History Taking ◽

Case Presentation ◽

Detailed History ◽

Radiological Features ◽

Common Etiology ◽

History Of ◽

Vegetative Matter

Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastrointestinal tract and are a rare cause of intestinal obstruction in children. Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction. Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.

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