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

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.

Mesenteric lipoma: a rare cause of acute small bowel obstruction

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.

Mesenteric Lipoma as an Uncommon Cause of Abdominal Discomfort

Lipoma is the most frequent benign mesenchymal tumor that resembles normal white fat. Gastrointestinal tract lipomas are rare. The small bowel is the second predilection site of lipomas following the colon. Mesenteric lipomas mainly occur in adults without gender predilection. They are usually asymptomatic and discovered incidentally. However; these tumors may present with intussusception and intestinal bleeding. CT is the key imaging modality to diagnose mesenteric lipoma. They typically present as well-circumscribed, non-enhancing masses with homogeneous fatty attenuation, which are often contained and separate from free mesenteric fat (Figure 1 and 2: white arrows). On MRI, mesenteric lipomas demonstrate homogeneous signal intensity identical to that of fat. Thin fibrous septa of low signal intensity on T1- and T2-weighted images may be present.