Wu Hsin-Yi, Huang Song-Fong, Pan Kuang-Tse, Yu Ming-Chin
Department of General Surgery, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Branch, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
Int J Surg Case Rep. 2018;45:91-95. doi: 10.1016/j.ijscr.2018.03.011. Epub 2018 Mar 15.
Ileal submucosal lipomas are rare cases and surgical intervention was necessary in case of abdominal pain and intussusception. Laparoscopic resection may be difficult for the intraluminal submucosal lesion. Herein, we report a case of terminal ileal submucosal lipoma resected by radiologic-assisted laparoscopic surgery.
The 31-year-old female was admitted for intermittent abdominal pain. The colonoscopy showed a 1.5 cm diameter subepithelial lesion in terminal ileum and computed tomography showed a hypodense lesion in distal ileum. The diagnosis of terminal ileal submucosal lipoma without obstruction was impressed and surgical strategy of minimal invasive surgery was taken. Preoperative CT-guided patent blue dye injection near the terminal ileal submucosal lipoma for localization was performed by Radiologist. Then laparoscopic resection with intracorporeal suture was done smoothly without complications. The pathology proved lipoma and she had good recovery within one week.
There are many kinds of intervention methods to treat the small bowel lipoma. Our experience supports that laparoscopic surgery with radiologic localization assistance is feasible for terminal ileal nonintussusceptive submucosal lipoma resection.
回肠黏膜下脂肪瘤较为罕见,出现腹痛和肠套叠时需进行手术干预。对于腔内黏膜下病变,腹腔镜切除可能具有挑战性。在此,我们报告一例通过放射学辅助腹腔镜手术切除的末端回肠黏膜下脂肪瘤病例。
一名31岁女性因间歇性腹痛入院。结肠镜检查显示末端回肠有一个直径1.5厘米的上皮下病变,计算机断层扫描显示回肠远端有一个低密度病变。诊断为无梗阻的末端回肠黏膜下脂肪瘤,并采取了微创手术的手术策略。放射科医生在术前对末端回肠黏膜下脂肪瘤附近进行CT引导下专利蓝染料注射以定位。然后顺利进行了腹腔镜切除并进行体内缝合,无并发症发生。病理证实为脂肪瘤,她在一周内恢复良好。
治疗小肠脂肪瘤有多种干预方法。我们的经验支持,放射学定位辅助的腹腔镜手术对于末端回肠非套叠性黏膜下脂肪瘤切除是可行的。