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A small intestine volvulus caused by strangulation of a mesenteric lipoma: a case report
© The Author(s). 2017
Received: 25 September 2016
Accepted: 31 January 2017
Published: 13 March 2017
An emergency department encounters a variety of cases, including rare cases of the strangulation of a mesenteric lipoma by the greater omentum band.
A 67-year-old Japanese man presented with nausea, vomiting, and upper abdominal pain. There were no abnormalities detected by routine blood tests other than a slight rise in his white cell count. A contrast-enhanced computed tomography scan of his abdomen revealed a dilated intestine, a small intestine volvulus, and a well-capsulated homogeneous mass. He was suspected of having a small intestine volvulus that was affected by a mesenteric lipoma; therefore, single-port laparoscopic surgery was performed. Laparoscopy revealed a small intestine volvulus secondary to the strangulation of a mesenteric lipoma. The band and tumor were removed. He had no postoperative complications and was discharged on postoperative day 6.
Although this case was an emergency, it showed that single-port laparoscopic surgery can be a safe, useful, and efficacious procedure.
Lipomas are benign neoplasms of adipose tissue that can occur almost anywhere. Mesenteric lipomas are uncommon , but strangulation of mesenteric lipomas is exceptionally rare. Here, we describe a case of a small intestine volvulus caused by strangulation of a mesenteric lipoma by the greater omentum band, which was successfully managed by performing single-port laparoscopic surgery.
A lipoma is a benign tumor of mature adipocytes. A lipoma can occur almost anywhere in the trunk, extremities, or even intraperitoneally, which is extremely rare with a small overall malignant potential . The differential diagnosis is liposarcoma, which has a high recurrence rate. However, as abdominal ultrasonography and magnetic resonance imaging may show typical findings [3–5], it is difficult to diagnose exactly in an emergency case. In the case of an emergency surgery, like the one presented here, complete removal of the mass is important.
A lipoma is often accidentally detected secondary to other symptoms. The symptoms in many cases are abdominal swelling, abdominal pain, or mass palpation . The symptoms in our case were nausea, vomiting, and upper abdominal pain, which were different from typical symptoms and it was thought that they were caused by a small intestine volvulus that was affected by a mesenteric lipoma. Strangulation of the mesenteric lipoma due to the greater omentum band was recognized as a cause of the volvulus during laparoscopic surgery.
The tumor was identified; however, the nature of its involvement in the twisting was not known. Therefore, the first operation was performed to resolve the twisting. Single-port laparoscopic surgery was chosen because the intestinal volvulus was believed to be corrected and it was expected that the surgery would not be very challenging to perform. In the case of the cancellation of the volvulus, the enucleation of the tumor, and the partial resection of the small bowel, laparoscopic surgery, specifically single port, is a very good adaptation. In the case of a small open surgery, we may overlook a tumor that is in other locations because we cannot observe it properly. In addition, pain reduction and early resumption of oral food intake are more likely to lead to shortening of the hospital stay. However, it is preferable for an operation to be performed by an expert surgeon because it is necessary to resolve the twisting and observe the entire small intestine at which time complications such as intestinal tract damage may be caused by the operation of forceps. If the operation is difficult, the addition of a port or a small laparotomy should be performed. We must remember that safety is the topmost priority.
The strangulation of a mesenteric lipoma by the greater omentum band is rare. To the best of our knowledge, this is the first report of not only the pathophysiology but also the treatment by single-port laparoscopic surgery.
The authors would like to thank Editage (www.editage.jp) for English language editing.
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This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium provided you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article unless otherwise stated.
YK drafted the manuscript. All authors performed surgery and read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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