A case report of small intestinal volvulus caused by lipomatosis of the small intestine successfully treated with enterectomy

TL;DR

A rare case of small intestinal volvulus caused by lipomatosis was successfully treated with surgery after being diagnosed using advanced imaging techniques.

Contribution

This case report provides a detailed account of a rare condition and highlights the diagnostic utility of three-dimensional enhanced computed tomography.

Findings

Three-dimensional enhanced CT imaging helped detect intestinal dilation and fat-like lesions, aiding diagnosis.

Surgical examination revealed over 100 lipomas in the affected intestinal segment.

Complete resection of the affected intestine improved patient prognosis and confirmed the diagnosis.

Abstract

Small intestinal lipomatosis is a rare condition that presents a diagnostic challenge due to the absence of identifiable clinical symptoms and limitations of small intestine examination methods. Consequently, preoperative diagnosis is difficult and only a limited number of cases have been documented in the scientific literature. Here, we report a rare case of volvulus caused by small intestinal lipomatosis. A 58-year-old female patient was tentatively diagnosed with acute ileus. The whirl sign was detected using abdominal three-dimensional enhanced computed tomography, along with marked local intestinal dilation and multiple irregular fat-like containing lesions. During surgery, abnormal dilation of the small intestine between 80 and 220 cm from the ileocecal valve was detected and the affected intestine displayed a folded and twisted configuration. Examination of the resected intestine showed that the inner wall of the diseased intestinal lumen was covered with more than 100 lipomas of different sizes, the largest of which measured ~8.0 cm in diameter. Based on clinical symptoms alone, it was difficult to identify the cause of intestinal volvulus before surgery. Complete resection of the affected small intestine and subsequent pathological analysis yielded a definitive diagnosis of small intestinal lipomatosis. While small intestinal lipomatosis is a rare condition, prognosis is favorable if diagnosed early and treated appropriately. The application of three-dimensional enhanced computed tomography imaging can aid in accurate diagnosis, while complete resection of the affected small intestine is crucial to improve patient prognosis.

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