The intestinal obstruction presenting as an emergency case when undergoes exploratory laparotomy present with multiple etiology associated such like intussusception that usually more common in infants and rare in adults. Similarly, lipoma the most common benign tumor over the body are rare in gastrointestinal, comprising about 3%. This paper presents a case report of a 51-year-old woman who presented with symptoms of bowel obstruction caused by ileo-ileal intussusception secondary to submucosal lipoma with the linking etiology of this gastrointestinal lipoma to be the causative factor for bowel obstruction resulting into the intussusception, yet another rare disease in adult as presentation. Thus, emphasizing the importance of considering such diagnosis in similar clinical scenarios.
A disease known as intestinal obstruction occurs when the small or large intestine's content such as gas and liquid passages are at hault. May be presenting with partial or complete bowel obstruction as a result of the peristaltic wave failing to transmit the content. It usually presents with an emergency scenario associated with symptoms like abdominal pain, vomiting, distension and obstipation.
Adults experiencing abdominal pain may have intussusception, an uncommon condition characterized by lead points that force a portion of the intestine to telescope into the surrounding area, causing symptoms of intestinal blockage and peritoneal irritation. This is an uncommon instance of ileoileal intussusception brought on by a submucosal lipoma that act as lead point.
Lipomas i.e. clustered mature adipocytes cells are the most frequent benign tumor that affects 3% of gastrointestinal tumors, the majority of which are found in the colon (60–75%) and S.I. (30%). It primarily affects individuals between the ages of 50 and 70, and it has the fundamental components of mature adipocytes with a fibrous capsule that surrounds them.
A 51-year-old lady, resident of bareilly got admitted with complain of pain in abdomen (acute in onset) since 3 days, vomiting since 2 days (multiple episode, non-bilious, non-bloody), unable to pass stool & flatus since 2 days with no previous history of any surgical operation.
On examination: Patient looked anxious & restless with tachycardia & some signs of dehydration. She was afebrile with temp: 36.8 ºC, pulse: 102, blood pressure, BP: 126/64 mm 0f hg, RR: 18, O2 saturation: 99% on room air) upon arrival to the emergency room. Per abdomen findings showed mild distended abdomen with lump over the umbilical region, sausage shape.
On auscultation: Bowel sound sluggish present. DRE findings showed no stool in rectum with anal tone normal, no polyp, no growth. On Investigation it was found deranged hematocrit with hbg 6.5 gm/dl, tlc within normal limits, S. Na+ 140 & S. K+ 3.0. Abdominal Xray erect AP view showed multiple gad fluid level. USG whole abdomen showed telescoping of bowel in left iliac fossa with lead point in forms if lipomas (ileo-ileal type).
CecT abdomen showed: edematous, dilated bowel loop showing gangrenous changes with the lead point suspected to be 3.2 cm approx.,mostly bowel lipoma.
Treatment: correction of dehydration was started with iv fluid after admission followed with nasogastric tube insertion. Immediately two unit blood transfusion was done & analgesic for pain relief was started. Emergency lapratomy was performed as step of management.
Intraop findings showed illeo-ileal intussusception with gangrenous bowel & multiple intramural lipoma (pedunculated). Reduction & Ressection anastomosis of bowel followed with removal of gangrenous part and excision of lipoma was done. The resected and excised lipoma was send for histopath examination.
While post op fluid, analgesic & antibiotic coverage was given followed with one unit blood transfusion. Regular sterile dressing with ADK drain care was followed & drain was removed on 4 th day.The enhanced recovery after surgery step was followed.The patient got discharged on 6th day with no surgery complication. Meanwhile biopsy report showed gangrenous bowel(ileum) and submucosal lipoma.
A 51-year-old lady, resident of bareilly got admitted with complain of pain in abdomen (acute in onset) since 3 days, vomiting since 2 days (multiple episode, non-bilious, non-bloody), unable to pass stool & flatus since 2 days with no previous history of any surgical operation.
On examination: Patient looked anxious & restless with tachycardia & some signs of dehydration. She was afebrile with temp: 36.8 ºC, pulse: 102, blood pressure, BP: 126/64 mm 0f hg, RR: 18, O2 saturation: 99% on room air) upon arrival to the emergency room. Per abdomen findings showed mild distended abdomen with lump over the umbilical region, sausage shape.
On auscultation: Bowel sound sluggish present. DRE findings showed no stool in rectum with anal tone normal, no polyp, no growth. On Investigation it was found deranged hematocrit with hbg 6.5 gm/dl, tlc within normal limits, S. Na+ 140 & S. K+ 3.0. Abdominal Xray erect AP view showed multiple gad fluid level. USG whole abdomen showed telescoping of bowel in left iliac fossa with lead point in forms if lipomas (ileo-ileal type).
CecT abdomen showed: edematous, dilated bowel loop showing gangrenous changes with the lead point suspected to be 3.2 cm approx.,mostly bowel lipoma.
Treatment: correction of dehydration was started with iv fluid after admission followed with nasogastric tube insertion. Immediately two unit blood transfusion was done & analgesic for pain relief was started. Emergency lapratomy was performed as step of management.
Intraop findings showed illeo-ileal intussusception with gangrenous bowel & multiple intramural lipoma (pedunculated). Reduction & Ressection anastomosis of bowel followed with removal of gangrenous part and excision of lipoma was done. The resected and excised lipoma was send for histopath examination.
While post op fluid, analgesic & antibiotic coverage was given followed with one unit blood transfusion. Regular sterile dressing with ADK drain care was followed & drain was removed on 4 th day.The enhanced recovery after surgery step was followed.The patient got discharged on 6th day with no surgery complication. Meanwhile biopsy report showed gangrenous bowel(ileum) and submucosal lipoma.
Acute intestinal blockage is a puzzling condition that can manifest in a variety of ways and have several different treatment options. With a low prevalence of 5–10%, adult small intestine intussusception accounts for only 1-5% of intestinal blockage in adults. It is a clinically uncommon condition. Adhesions, polyps, viral infections, lipomas, Meckel's diverticulum, gastrointestinal stromal tumors, lymphomas, and other malignancies are among the etiologies of the lead point of intussusception. Consequently, unless absolutely certain, intussusception should not be ruled out in an adult patient experiencing abdominal pain. In our instance, an intestinal lipoma was the primary cause of the intussusception that resulted in small bowel blockage. A lipoma is a soft, painless, tumor of fat cells that can fluctuate in size and is considered benign. Generally speaking, they live wherever normal fat cells rule. There are generally three forms of intestinal lipomas that are examined, specifically small bowel lipomas: intermuscular lipomas, sub serosal lipomas, and submucosal lipomas, of which the submucosal type is the most prevalent. Either sessile or pedunculated behavior is possible. maybe lobulated or regular in shape.
Intravenous fluids and supportive therapy are commonly used in the conservative, non-operative management of intussusception, particularly in the pediatric population. Ileocolic intussusception is lessened with the use of barium enemas combined with air contrast. Nonetheless, intraoperative intervention to remove the blockage and potentially resect the ischemic bowel is the course of action if the intussuscepted intestine exhibits signs of intestinal obstruction, ischemia, or necrosis brought on by the lead point. Similarly, our initial option for treating our patient, who had diffuse discomfort and a full intestinal blockage, was surgery.
In clinical practice, tiny intestinal lipomas and intussusceptions are uncommon. To diagnosis these rare cases, a thorough history, physical examination, and pertinent auxiliary tests must be obtained. The preferred course of treatment is still surgery, which also has a very good prognosis.
Conflict Of Interest: The authors declare no conflict of interest.
Funding: No funding sources.
Ethical Approval: The study was approved by the Institutional Ethics Committee
GI lipomas, primarily located submucosally (90%) and subserosally (10%), are mesenchymal tumors usually asymptomatic but can present with bleeding, intussusception, obstruction, or perforation. Small intestinal tumors account for only 1-2% of all GI tumors, with approximately 30% being benign lesions. Benign lesions, including lipomas larger than 4 cm, are significant causes of intussusception and obstruction.
The combination of a small intestinal lipoma with intussusception is rare but critical to diagnose through detailed history, clinical examination, and ancillary tests. Surgical resection remains the treatment of choice, offering an excellent prognosis.
## Conclusion
GI lipomas, although rare, should be considered in the differential diagnosis of adult intussusception and intestinal obstruction. Prompt surgical intervention is crucial for favorable outcomes.
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