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A case of liposarcoma with peritonitis due to jejunal perforation
Hisashi Horiguchi1, Miwa Matsui, Tatsuo Yamamoto
1Center for Medical Sciences Ibaraki Prefectural University of Health Sciences Ami, Ibaraki Inashiki 300-0394 Japan.
Insights
A rare case of jejunal perforation caused by an unclassified abdominal liposarcoma highlights the diagnostic challenges of intestinal perforation. Early identification and thorough pathological examination are crucial for managing such unusual presentations.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Imaging
Background:
- A 21-year-old male with a history of congenital bile duct dilatation presented with acute abdomen and peritonitis.
- Emergent laparotomy revealed jejunal perforation, necessitating resection of a 60-cm segment.
- Initial findings excluded macroscopic tumors, with only serosal thickening noted in the resected jejunum.
Purpose of the Study:
- To investigate the cause of jejunal perforation in a patient with a history of abdominal surgery.
- To identify the underlying pathology despite initial negative intraoperative findings.
- To emphasize the importance of detailed histological examination in unusual clinical scenarios.
Main Methods:
- Clinical presentation and surgical findings were documented.
- Histopathological examination of the resected jejunal segment was performed.
- Differential diagnosis considered the possibility of a metastatic or occult primary tumor.
Main Results:
- Histological examination unexpectedly revealed an unclassifiable liposarcoma.
- The tumor's distribution suggested a possible primary lesion elsewhere, with secondary involvement of the jejunum.
- The patient succumbed to septic shock post-operatively.
Conclusions:
- Abdominal liposarcomas, though rare, can present with life-threatening complications like intestinal perforation.
- Vascular compromise due to tumor cell spread may lead to perforation.
- Clinicians and pathologists must maintain a high index of suspicion for occult malignancies in cases of unexplained intestinal perforation, especially in patients with prior abdominal surgery and adhesions.
Abstract:
A 21-year-old man, who had been treated for congenital dilatation of the bile duct 13 years previously, presented with an acute abdomen. The physical examination suggested peritonitis, and an emergent laparotomy was performed. A perforation was foundin the jejunum approximately 100 cm distal to the ligament of Treitz, followed by resection of a 60-cm jejunal segment. No tumorous lesions were found during the operation, and the resected jejunal segment showed only focal myxomatous thickening of the serosa. Despite intensive therapy, he died of uncontrollable septic shock 2 days after the operation. Unexpectedly, however, histological examination revealed a liposarcoma, showing an unclassifiable histology. From the distribution of the lesion and the histological findings, it is thought that a primary lesion was somewhere else, covered by severe adhesions due to the previous operation, and that the tumor cells spreading from it could have caused the jejunal perforation through vascular involvement. Although extremely rare, liposarcomas in the abdomen can cause intestinal perforation. It is important for both clinicians andpathologists to carefully investigate the cause of an unusual clinical presentation such as intestinal perforation.
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