Niranjan Sahoo

A small intestinal lipoma with torsion. Review of literature

BackgroundSmall intestinal tumours are rare. Malignant tumours include adenocarcinoma, sarcoma and lymphoma. Benign small intestinal tumours are still uncommon and include leiomyoma, lipoma, angioma, adenoma, neurofibroma and fibroma. These benign tumours largely go undetected until they produce complications such as intestinal obstruction, intussusception, bleeding, pain etc. Some are diagnosed incidentally on resected specimen.Case ReportA 21-year-old boy presented with features of intestinal obstruction and left iliac fossa mass. On emergency laparotomy, a firm ileal mass with torsion was detected and resected, which was confirmed on histopathology as submucosal lipoma with haemorrhage.DiscussionLipoma of the small gut is a rare benign mesenchymal tumour and is asymptomatic until becoming large enough to be symptomatic. Some are diagnosed on the operating table and some in the resected specimen. A plain x- ray of the abdomen, barium contrast study and USG has limited diagnostic value. MDR-CT of the abdomen can diagnose intestinal lipoma due to its uniform appearance and density and the negative Hounsfield Unit (HU-minus 50).ConclusionSmall intestinal lipomas are rarely encountered and difficult to diagnose pre-operatively in surgical practice. If diagnosed or found incidentally, they should be excised to prevent life-threatening complications.