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.
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