Pedunculated Lipoma Research Articles

Pedunculated lipoma of the breast

Pedunculated lesions of the breast are usually benign conditions. They pose a clinical dilemma to the attending surgeon. Excision is the mainstay of treatment. A case of a pedunculated lipoma of the breast in a 52-year-old lady is presented. She underwent excision under general anesthesia. Histopathology revealed adult-type of adipocytes with no evidence of lipoblasts. There was no recurrence. Various types of pedunculated lesions of the breast, their diagnosis and management are discussed. Surgical excision is the mainstay of treatment. They have a low recurrence rate and are rarely malignant.

Colonic intussusception from pedunculated colonic lipoma at hepatic flexure: A case report and review of current literature

Colonic lipomas are a benign tumor that can present in multiple ways, including; incidentally, abdominal pain, change in bowel habit, bleeding, intestinal obstruction and intussusception. We present the case of a 48-year-old gentlemen who presented to the emergency department with a 3 day history of abdominal pain and was found to have a 5 cm intramural ischemic pedunculated colonic lipoma causing intussusception and large bowel obstruction. He received initial management with emergency laparoscopic exploration, reduction of intussusception, colotomy and lipoma excision. He made a full recovery. The current approaches to management of colonic lipomas are conservative, endoscopic or surgical. This case highlights the potential consequences of untreated colonic lipomas. In our review of the literature, we highlight that there is a lack of clear consensus on appropriate management of these patients.

Strangulation of the caecum by a pedunculated lipoma in a Rocky Mountain Horse gelding

SummaryA 19‐year‐old Rocky Mountain Horse gelding was presented for emergency evaluation of colic. A pedunculated lipoma was found to be strangulating the caecum and ileocaecal junction at surgery. Following the resolution of the incarceration, it was found that the pedicle originated on the jejunal mesentery, but the stalk did not appear long enough to have formed a half‐hitch around both the caecum and ileum. The horse was euthanised due to complete caecal devitalisation. A second pedunculated lipoma was identified at necropsy, located on the transverse colon with an area of ischaemia on the mesenteric pedicle (the abnormal stalk of tissue connecting the lipoma to the colonic mesentery), consistent with pressure from being entwined with the jejunal mesenteric pedicle. This report is the first to describe caecal and ileal incarceration and strangulation by a pedunculated lipoma in a horse.

Management of Medoja Granthi (pedunculated lipoma) by Apamarga Ksharasutra ligation and Ayurveda medications: A case report

Abstract INTRODUCTION: A pedunculated lipoma is a benign fat tissue tumor conventionally treated by surgical excision. This condition can be correlated with Medoja Granthi. Ksharasutra ligation is an effective minimal invasive parasurgical procedure suggested for its management in Ayurveda. MATERIALS AND METHODS: In this case report, a 65-year-old female patient came with complaints of swelling at the lateral aspect of the right upper arm, which was of normal skin color, mobile, nontender without any dilated veins, or elevated local temperature since 5 years and was diagnosed as Medoja Granthi. She was treated with Apamarga Ksharasutra ligation locally along with Triphala Guggulu (250 mg), two tablets twice a day orally with lukewarm water for 10 days, and Yastimadhu Ghrita local application at the base for 12 days. RESULTS AND CONCLUSIONS: In this case study, the pedicle of the lipoma de-sloughed completely on the 10th day of Ksharasutra ligation. Thus, Apamarga Ksharasutra therapy showed promising outcomes in pedunculated lipoma treatment without any adverse effects. Randomized clinical trials on an appropriate sample size can help establish the clinical efficacy of the treatment procedure adopted in the current case study in the management of Medoja Granthi.

Diagnostic wandering of a case of giant pedicled lipoma of the left inguinal fold

ABSTRACT Lipomas are usually benign tumors formed from a proliferation of mature adipocytes, resulting in hypodermic, soft, compressible, and mobile nodular formations under the skin. In their subcutaneous location, superficial lipomas represent 16% to 50% of soft tissue tumors. They may be solitary or multiple. Solitary lipoma is usually seen in young adults between the ages of 30 and 50 years, regardless of sex, and is frequently asymptomatic. A lipoma is called giant when its weight exceeds 1 kg or its diameter exceeds 5 cm. The etiopathogenesis of lipomas is poorly understood. Herein, we report a case of giant pedunculated lipoma localized on the left inguinal fold being a distress for the patient. Key words: Giant pedunculated lipoma, Diagnostic wandering, Ablation, Burkina Faso

209 Giant Mesenteric Lipoma: an atypical presentation of an unlikely hero

Abstract Background Mesenteric lipoma’s are a rare and benign mesenchymal tumour originating from mature adipocytes within the gastrointestinal tract. In most cases, they do not cause symptoms. A search of English literature revealed less than 100 reported cases. In those who are symptomatic, presenting symptoms are variable. We present an unusual case of a mesenteric lipoma aiding in the diagnosis of a colorectal cancer. Case report A 77 year old lady presented to her GP with chronic abdominal pain. On examination she appeared to have lost weight. Her initial investigations showed a new anaemia. Her FIT was negative. A CT Colon showed a 3.5cm flat lesion in the caecum. Histology, obtained via colonoscopy, proved this to be an Adenocarcinoma. The patient underwent a Laparoscopic converted to open right hemicolectomy. Intraoperatively the caecum was found in the pelvis with a pedunculated lipoma originating from the mesentery overlying the ileocolic artery. Post-operative histology showed a fully resected Adenocarcinoma as well as a 200mmx90mmx20mm giant mesenteric lipoma. Discussion We hypothesis that this patient’ presenting symptom of abdominal was unlikely to be due to the colorectal cancer. It is feasible that her pain was secondary to the compressive effect of the lipoma on the caecum and terminal ileum. Without symptoms, it is unlikely the patient would have presented to her GP and the malignancy would likely not have been found at such an early (and resectable) stage. Conclusion The mesenteric lipoma was likely the unsung hero for this patient.

Delayed iatrogenic diaphragmatic hernia after thoracoscopic resection of diaphragm lipoma

BackgroundIatrogenic diaphragmatic hernias have been reported as a rare complication of thoracic and abdominal surgery. We herein report a case of delayed iatrogenic left diaphragmatic hernia after diaphragm pedunculated lipoma resection with minimally invasive surgery.Case presentationA 72-year-old Japanese man was found to have an abnormal shadow by medical checkup X-ray and was admitted to our hospital. Chest computed tomography (CT) showed a 5 × 2-cm solid tumor at the left diaphragm. He was diagnosed with a left diaphragm tumor. We performed three-port video-assisted thoracic surgery. This tumor was pedunculated at the left central tendon of the diaphragm. We therefore dissected this tumor using an electric scalpel. Although there was about 5 × 4 mm in diameter slight heat damage to the diaphragm, it was not reinforced because it was very minor injury. He was diagnosed with a left diaphragmatic hernia without any symptoms by routine CT examination which scheduled 1 year after surgery. One day after hospitalization, on the morning of the operation, he suddenly complained of left back pain with acute exacerbation of the left diaphragmatic hernia. We therefore immediately performed emergency surgery and rescued this patient. No adverse events or complications were seen, and he was discharged on postoperative day 11. Three months after this surgery, this patient is doing very well.ConclusionsCaution should be exercised when using energy devices on the diaphragmatic surface, especially the left side, to avoid causing delayed diaphragmatic hernia. In cases of surgery involving the left-side diaphragm, it seems that careful follow-up after surgery is necessary.

Endoscopic resection of a giant pedunculated lipoma arising from the ileocecal valve and causing ileocolic intussusception.

Endoscopic resection of a giant pedunculated lipoma arising from the ileocecal valve and causing ileocolic intussusception.

Colorectal intussusception caused by a pedunculated lipoma: A rare case report

Intussusception is a rare condition in adults and can have various causes, including cancer. A man aged 35 presented to the emergency department with abdominal pain, abdominal distension, and rectal bleeding. A CT scan revealed that a lipoma in the recto-sigmoid region had caused the intussusception, resulting in a mechanical obstruction. To treat this, the intussusception was reduced, and part of the sigmoid was removed with an end colostomy. It is essential to consider the possibility of malignancy when managing adult intussusception as reducing a malignant segment may cause dissemination. While intussusception caused by non-malignant lesions such as lipomas is known to occur, it is more common in the right and transverse colons.

A rare case of colonic lipoma causing colo-colonic intussusecption

Gastrointestinal tract (GIT) lipomas are rare, benign mesenchymal neoplasm affecting all segments of the GIT and colon is affected most frequently. Reported incidence of colonic lipomas varies from 0.2% to 4.4%. Adult intussusception represents 1% of all bowel obstructions and 5% of all bowel intussuceptions. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitute an infrequent clinical entity. Although intussusception is a common disease in children, intussusception caused by colonic lipoma in adults is a rare condition, and is usually caused by a large pedunculated lipoma. The majority are asymptomatic but may cause abdominal pain, obstruction or bleeding. The treatment for symptomatic or large lipomas is surgical excision. We would like to report a unique case of an elderly lady with colonic lipoma causing colo-colonic intussusception. After thorough investigations, exploratory laparotomy with colo-colonic anastomosis was done.

A Rare Case of Accessory Breast Mimicking Lipoma in a Male

Accessory breast tissue is a rare condition in which there is a presence of breast tissue in an ectopic site in addition to normal site. It occurs in about 0.4-6% of women and 1.68% occurrence is seen in men. The obstacle to management comes in the diagnosis of the accessory breast tissue. The commonest site is the axilla, and the other sites of occurrence are groin, buttock and thigh. The disease may present as a unilateral swelling with changes occurring during the time of pregnancy, lactation and menses due to the influence of hormones. This breast tissue also undergoes the changes that occur in a normal breast tissue such as fibrocystic changes or carcinomatous changes. A case of accessory breast tissue was reported in a 28-year-old-male which was initially suspected to be a pedunculated lipoma in the right axillary region and later on histopathological evaluation diagnosed to be an accessory breast tissue.

Hypothesis on the pathophysiology of small intestinal strangulation by a pedunculated lipoma

SummaryThe current hypothesis proposed for strangulation of small intestine by a pedunculated lipoma in horses involves movement of the lipoma around the small intestine until it loops through its own pedicle. This mechanism is difficult to demonstrate during surgical correction. The objective was to examine an alternative explanation for strangulation by pedunculated lipomas that is logical and consistent with intraoperative findings by the analysis of the anatomical features of 11 cases of lipoma strangulation in horses. In the proposed hypothesis, the stalk of the lipoma is tensed by the weight of the lipoma alone or by external forces on it from adjacent intestine. This produces a slit‐like aperture formed by the stalk and the contiguous mesentery. One or more loops of intestine pass across the lateral edge of the stalk before turning into this aperture, either because of lack of space in the abdominal cavity or through the effects of peristalsis. The weight of the intestine itself causes the loop to ‘fall’ into the aperture and become entrapped. This creates a half‐hitch knot in which the loop of intestine uses the lipoma pedicle as a ‘post’ around which it becomes strangulated. It was concluded that the proposed hypothesis differs from the existing one by requiring intestinal movement to create the strangulation, which is more plausible than the current proposal that the strangulation is caused by movement of the lipoma itself. It is also more consistent with surgical findings.

Small Intestine Strangulating Obstruction by Mesenteric Pedunculated Lipoma in a Criollo Mare

Background: The abdominal lipomas are benign tumors of hyperplastic growth that originate from mesenteric adipose tissue, most commonly in the small intestine. Pedunculated lipoma strangulation occurs when the pedicle wraps around an intestinal loop and its mesentery, obstructing the intestinal lumen and blood supply of the affected segment. The aim of the present study is to report a case of a Criollo mare presenting a strangulating obstruction of the jejunum and ileum by a pedunculated lipoma, focusing the discussion in the causes and epidemiology of this alteration.Case: A 24-year-old Criollo mare with a body condition score 8 out of 9 was referred to a Veterinary Clinical Hospital of the Federal University of Pelotas (HCV-UFPel) presenting acute abdominal pain. At the hospital, the mare was presenting mild signs of abdominal discomfort. At the initial clinical exam, the mare had an increased heart and respiratory rates, normal body temperature, hyperemic mucous membranes, capillary refil time of 3 s and absent gut sounds in all four quadrants during auscultation. Mild dehydration was present, increased fibrinogen and serum lactate. Rectal palpation revealed distention of the small intestine by gas, during abdominal ultrassonography the small intestinal wall thickness was found increased. Peritoneal lactate was 11 mmol/L and protein was 6 mg/dL. Due to the clinical findings during the exam, an exploratory celiotomy was performed. Necrosis of the final third of jejunum and the entire extension of ileum was found. Examining the compromised intestinal portion, it was observed a linear structure strangulating two segments of the small intestine. Taking into account the extensive area of irreversible necrosis and the advanced age of the patient, euthanasia was performed. The mare was then referred for necropsy and findings confirmed the strangulation of the final portion of the jejunum and all the extension of the ileum caused by a mesenteric pedunculated lipoma.Discussion: Increased mesenteric fat can predispose horses to the development of mesenteric lipomas. Although there is no scientific evidence of the association of mesenteric lipoma and obesity, it has been observed that pedunculated lipomas are more common in horses with metabolic alterations, for example, Criollo breed, that is potentially predisposed to develop metabolic disturbances. Elderly horses are at the highest risk of colic by mesenteric lipoma, as well as geldings, however, others authors describe that females are more commonly affected. Horses considered of short stature are more predisposed when compared to jumping or race horses. Pedunculated lipoma occurs in 18% of all cases of treated colic and is found more frequently in the small intestine when compared to the smaller colon. In most cases, surgery is indicated and resection of the pedicle and the affected segment may be necessary, however, in this case, the extensive area of intestinal necrosis and the impossibility of externalization of the affected segment lead the decision to proceed with euthanasia. In conclusion, the mare of the present study had an advanced age and a high body condition score, which the authors’ believe were two predisposing factors that increased the risk of it developing a mesenteric lipoma. Considering that, further epidemiologic studies should be conducted to better understand this relation.

Ileal Bypass Followed by Tiflostomy to Treat Acute Abdomen in a Horse

Background: Equine gastrointestinal colic cases represent one of the diseases with higher morbidity and mortality. Short and long term survivals are commonly correlated with the colic causes, being considered 50% the survival rate of horses referred to surgery because of small intestine strangulative causes. The jejuno-caecostomy technique is recommended in cases of ileum necrosis or ischemia that indicates ileum removal. The survival rate after this procedure is low, being even lower than others common terminal-terminal enteroanastomoses. This study reports a case of jejuno-caecostomy followed by tiflopexy and tiflostomy performed in a colic horse.Case: A 12-year-old mare, mangalarga breed, with a history of acute abdomen during 18 h was referred to the FZEA-USP equine hospital. According to the owner, the animal suffered previous episodes of colic that had been solved without treatment. On this occasion, the owner, without veterinary advice, had administered 10 mL of flunixin meglumine, but the animal did not show improvement. During the examination, the patient presented tachycardia, tachypnea, toxemic mucosa, a large amount of enterogastric reflux, and it was possible to observe distended small intestine during rectal palpation. The horse was referred to surgery; it was possible to identify necrosis of the ileum and 30 cm of the aboral segment of the jejunum, caused by strangulation due to a pedunculated lipoma localized in the medial band of the caecum. Latero-lateral jejuno-caecostomy was performed between the medial and dorsal bands of the caecum, using polyglactin 910, nº 2.0, potassium penicillin 30.000 IU / kg, every 6 h, gentamicin 6.6 mg / kg, every 24 h, flunixin meglumine 1.1 mg / kg, every 12 h and maintenance fluid therapy were performed post operatively. The animal had ileus and severe enterogastric reflux for five days postoperatively, showing severe signs of endotoxemia, and parenteral hydration seemed to be not enough. So it was decided to hydrate the animal through the caecum. It was performed a tiflostomy and the implantation of a Foley catheter, nº 24, followed by tiflopexy. During this procedure, it was possible to diagnostic, via intra-abdominal palpation, a significant type I cecal impaction. Immediately after the procedure, the animal presented no more enterogastric reflux and started to defecate pasty manure. Two days after the procedure, the animal died. During necropsy, the anastomoses region showed a great healing process, without folds or stenosis and the functional test of the region was performed, showing no leakage, ensuring the success of the anastomosis technique; the tiflopexy was adequate, and the other intestinal segments presented normal.Discussion: In this report it was possible to observe several postoperative complications such as enterogastric reflux, type I caecum impaction, ileus, and endotoxemia, which was determinant for the death of the animal. Probably the cecal impaction was responsible for the enterogastric reflux and ileus, contributing with the endotoxemia and hydro electrolytic imbalance. These facts evidenced the necessity of faster and more efficient actions in future cases with similar complications, such as the accomplishment of a tiflostomy more precociously avoiding the impaction of caecum and minimizing the electrolytic imbalances of the patients. It was concluded that the delay in the patient referral, followed by the advanced hydro electrolytic imbalance and endotoxemia were the main factors responsible for the treatment failure.

A standing pararectal approach to treat small colon obstruction by a pedunculated lipoma

SummaryIn an 18‐year‐old Paso Fino mare presented with mild colic of 36 h duration, a luminal obstruction was found on rectal palpation in the most oral part of the rectum, and this appeared to be caused by a tight band on the left side. A standing procedure was used that involved pararectal dissection with long‐handled instruments to the level of the constricting band, guided by a hand in the rectum. A hooked bistoury designed for treating entrapped epiglottis was used to transect the band, which immediately released the obstruction and allowed manual evacuation of the aboral end of the small colon. The band was most likely the pedicle of a pedunculated lipoma that had encircled the oral end of the rectum. The mare made a complete recovery.

Laparoscopic resection of a sigmoid colon lipoma in a young female patient: A case report and review of the literature.

Lipomas of the sigmoid colon are rare entities. The present case describes a 27-year-old Caucasian woman who underwent a laparoscopic sigmoidectomy following the detection of a giant lipoma. The young patient was referred to the Emergency Department of the University Hospital of Heraklion (Crete, Greece) in May 2013 after experiencing intermittent abdominal cramping during defecation, and altering episodes of diarrhea and constipation. In addition, the patient described the protrusion of a solid tissue mass shaped like a 'champagne bottle cork' from the anus following defecation. These symptoms had been present for 1 month prior to referral. Physical examination was unremarkable. An urgent colonoscopy revealed a polypoid lesion measuring 2.5 cm in diameter in the sigmoid colon, which was located ~12 cm above the anal ring, with a smooth surface and tissue fragility. Tissue samples were obtained and sent for histopathological analysis. Preoperative contrast-enhanced computed tomography was performed urgently and confirmed the presence of a solid mass in the sigmoid colon without enlargement of regional lymph nodes. Following adequate preparation, the patient underwent a laparoscopic sigmoidectomy with intracorporeal termino-terminal colorectal anastomosis, with the use of a circular stapler. The patient had a positive post-operative outcome without complications and was discharged on day 4 post-surgery in an optimal condition. Histopathological examination of the surgical specimen demonstrated a pedunculated lipoma shaped like a 'champagne bottle cork'. The tumor consisted of mature adipose cells. The overlying colonic mucosa showed hyperplastic crypts with regenerative changes. In the lamina propria mild inflammatory infiltration was observed. At 2 years post-surgery, the patient remains asymptomatic without any clinical evidence of recurrence.

Giant vulvar pendulated lypoma in patients with endometrial adenocarcinoma and inoperated giant ventral hernia

Abstract A case is presented of a operated giant pedunculated vulvar lipoma weighing 14 kg in a patient with concomitant inoperable giant ventral postoperative hernia, complete diastasis of the anterior abdominal wall musculature and endometrial adenocarcinoma.

Laparoscopy-Assisted Resection of Ileocecal Intussusception Caused by Ileal Pedunculated Lipoma

We report on a case of ileal lipoma that prolapsed into the ascending colon and was resected by laparoscopy-assisted surgery. A 31-year-old male Japanese patient was admitted to our hospital because of hematochezia and anemia. Colonoscopy revealed a pedunculated polyp arising from the ileum. The surface was covered with slightly edematous mucosa. Abdominal computed tomography showed a low-density mass in the ascending colon. A diagnosis of pedunculated ileal lipoma with intussusception was made, and laparoscopy-assisted surgery was performed. The intussusception was reducted by resection of the lipoma. The surgical specimen was a 40 × 30 × 25 mm round tumor with a long stalk 11 cm in length. Microscopic examination of the specimen revealed ileal lipoma. Laparoscopic surgery is recommended for benign tumors of the small intestine because it is minimally invasive.

A Case of Giant Lipoma Causing Chronic Recurrent Intussusception of the Colon

Colonic lipomas, which often occur in elderly women, usually have small size and occur mainly in the cecum and ascending colon. Most colonic lipomas are asymptomatic and identified incidentally at the time of endoscopy or surgery. However, they may cause symptoms such as bleeding, obstruction or intussusception as their size increases. Intermittent episodes of intussusception are uncommon but may be caused by large pedunculated lipoma. In a 68-year-old woman suffering intermittent abdominal pain, 5.5×4.5×3.8-cm huge mass was found by colonoscopy at proximal ascending colon, which was intussuscepted to proximal transverse colon on abdominal computed tomography. Segmental right colonic resection was conducted. We report a case of symptomatic giant pedunculated colonic lipoma causing intussusception requiring surgical intervention, with a successful recovery after surgery.

Complicated colonic intussusception

The manuscript deals with the case of a 53-year-old woman who developed large bowel obstruction. Per-rectal examination revealed a pedunculated lesion in the rectum; rigid sigmoidoscopy revealed a prolapsing pedunculated mass with a necrotic surface. The patient recovered well following anterior resection. Histology confirmed a pedunculated sub mucosal lipoma as the lead point for intussusception. Colonic intussusception is a rare cause of adult large bowel obstruction, and the preoperative clinical diagnosis of this condition can be difficult. Resection of the involved segment of the colon is the most appropriate choice of treatment in most such cases.