# Late Ileocolic Anastomotic Stricture Due to Subserosal Lipoma: A Case Report

## TL;DR

A rare case of a late ileocolic anastomotic stricture caused by a subserosal lipoma is reported, highlighting the need for early surgical intervention when endoscopic treatment fails.

## Contribution

This case report identifies a subserosal lipoma as a rare cause of anastomotic stricture and emphasizes the importance of early surgical evaluation.

## Key findings

- A subserosal lipoma was identified as the cause of an anastomotic stricture 10 years after ileocecal resection.
- Endoscopic passage failed, necessitating surgical resection of the affected anastomotic segment.
- Histology confirmed a benign subserosal lipoma without atypia or lipoblasts.

## Abstract

Anastomotic strictures after ileocolic surgery are most often related to technical, ischemic, or inflammatory factors, with tumor recurrence also in the differential; a subserosal lipoma arising at the anastomosis is rare. We report a man in his 60s, 10 years after an ileocecal resection for appendicitis with abscess, who presented with right-sided abdominal pain and repeated vomiting. Contrast-enhanced CT demonstrated small-bowel wall hyperenhancement with fluid retention and a tight narrowing at the ileocolic anastomosis. After stabilization, colonoscopy showed edematous, ulcerated mucosa and a non-traversable stricture; biopsies revealed only inflammatory changes. Fluoroscopic balloon dilation was attempted, but guidewire cannulation failed, and conservative management was judged unlikely to succeed; therefore, the anastomotic segment was resected. Gross examination revealed compression of the bowel wall by subserosal adipose tissue with blunting of mucosal folds. Histology showed nodular proliferation of mature adipocytes in the subserosa without atypia or lipoblasts, consistent with a benign subserosal lipoma. Recovery was uneventful, and the patient was discharged on postoperative day 15. This case highlights subserosal lipoma at an ileocolic anastomosis as an uncommon cause; when endoscopic passage is impossible and imaging suggests an extraluminal fatty component, early surgery should be considered.