A Case of Pedunculated Intestinal Lipoma which Caused Ileus by its Torsion

Fumio Hara, Hiroshi Oka, Masakazu Tanimura, Kyo-on Lee, Takuya Takayama, Daisuke Ikeda, Akiharu Okamura*, Noriko Sakaida*

Division of Surgery, Moriguchi Keijinkai Hospital
*Department of Surgical Pathology, Kansai Medical University Hospital

A 52-year-old man was hospitalized because of sudden onset of lower abdominal pain. An abdominal X-ray showed a typical stepladder sign of ileus indicating obstruction at the terminal ileum. CT demonstrated a low density apple-sized round tumor within the pelvic cacity. MRI revealed the same tumor with both T₁ and T₂ high signal ranges which made us suspect lipoma. We were so certain the ileus was caused by this tumor, that a laparotomy was performed. The oval, pedunculated, and yellowish tumor, measuring 10×10×12 cm and covered by a thin white membrane, was located on the anti-mesenteric side of the ileum 30 cm proximal from the ileocecal valve and was twisted 3 times. The ileum at the tumor base was also twisted nearly 360°. Therefore the ileum was obstructed mechanically and its circulation was disturbed. A fresh cut surface of the tumor was dark brown with scattered hemorrhage and looked like fatty liver. Macroscopic diagnosis was confused and partial resection of the ileum was carried out. Histological evaluation disclosed that the tumor was a necrotic lipoma. Necrosis of the tumor caused by peduncular torsion which intercepted the blood supply turned the yellowish color to dark brown. A subserosal pedunculated intestinal lipoma that caused ileus by its torsion seemed rare enough to be reported.

Key words
intestinal lopoma, ileus, peduncular torsion

Reprint requests
Fumio Hara Moriguchi Keijinkai Hospital
2-47-12 Yagumohigashi, Moriguchi, 570-0021 JAPAN

Accepted
November 5, 1997

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