Hu Qiang, Wu Jinfeng, Sun Yuanshui
Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Front Surg. 2022 Jun 30;9:915114. doi: 10.3389/fsurg.2022.915114. eCollection 2022.
Adult intussusception is a rare disease that is difficult to diagnose and treat and is even rarer when it is caused by a lipoma of the small intestine. We reported a case of a small intestine lipoma combined with intussusception, which can guide people in future clinical work.
A 51-year-old female was admitted to the hospital with "abdominal pain for 1 month." Enhanced computed tomography (CT) of the abdomen suggested a lipoma in the left lower quadrant and a proximal intussusception. After excluding surgical contraindications, laparoscopic exploration was performed on the second day of admission, which showed a small amount of ascites in the abdominal cavity, a small intestine-small intestine-type intussusception about 20 cm from the ileocecal area and about 140 cm from the ileocecal area, and a mass of about 2×4 cm that was palpable by laparoscopic intestinal forceps, which was protruded into the intestinal cavity with a soft texture and sound mobility. A 5 cm-long incision was made above the mass to dissect into the abdomen layer by layer, and the diseased intestine was dislodged outside the abdominal cavity with oval forceps. The intestine was reduced by hand and observed for half an hour after reduction, and the blood circulation and peristalsis of the intestine were observed to be still sound. The intestine was dissected at 2 cm from the upper and lower margins of the mass using linear anastomosis to operate small intestine side-to-side anastomosis. The intestine was opened concurrently and closed with a linear anastomosis, using 3-0 absorbable thread to reinforce anastomosis intermittently. The procedure went smoothly, and the patient was discharged on the 5th postoperative day.
A small intestinal lipoma combined with small intestinal intussusception is rare in clinical practice and needs to be diagnosed by asking history detailedly, physical examination, and relevant ancillary tests such as abdominal CT. Laparoscopic-assisted small incision surgery for adult intussusception combines the advantages of laparoscopic surgery and laparotomy, operating simply and easily.
成人肠套叠是一种罕见疾病，诊断和治疗困难，由小肠脂肪瘤引起的成人肠套叠更为罕见。我们报告了一例小肠脂肪瘤合并肠套叠的病例，可为今后的临床工作提供指导。
一名51岁女性因“腹痛1个月”入院。腹部增强计算机断层扫描（CT）显示左下腹有一个脂肪瘤，近端肠套叠。排除手术禁忌证后，于入院第二天进行腹腔镜探查，结果显示腹腔内有少量腹水，距回盲部约20 cm和距回盲部约140 cm处为小肠-小肠型肠套叠，腹腔镜肠钳可触及一个约2×4 cm的肿物，该肿物突入肠腔，质地柔软，活动度良好。在肿物上方做一个5 cm长的切口，逐层切开进入腹腔，用卵圆钳将病变肠管移出腹腔。手动复位肠管，复位后观察半小时，观察到肠管血液循环和蠕动仍良好。在距肿物上下边缘2 cm处切断肠管，采用直线吻合器行小肠侧侧吻合。同时打开肠管，用直线吻合器关闭，用3-0可吸收缝线间断加固吻合。手术过程顺利，患者术后第5天出院。
小肠脂肪瘤合并小肠肠套叠在临床实践中较为罕见，需要通过详细询问病史、体格检查以及腹部CT等相关辅助检查来进行诊断。腹腔镜辅助小切口手术治疗成人肠套叠结合了腹腔镜手术和剖腹手术的优点，操作简单易行。
