Small Bowel Obstruction due to Intestinal Xanthomatosis

Area of Science:

• Gastroenterology
• Pathology
• Radiology

Background:

• Bowel obstruction commonly results from adhesions, malignancy, inflammatory disease, or hernias.
• Uncommon causes of bowel obstruction require prompt recognition to reduce mortality.
• Xanthomatosis, characterized by cholesterol-rich foamy macrophages, can manifest as a nonneoplastic lesion causing intestinal obstruction, primarily reported in the jejunum.

Purpose of the Study:

• To report a case of small intestinal xanthomatosis presenting as a cause of small bowel obstruction.
• To emphasize the importance of considering xanthomatosis in the differential diagnosis of jejunal obstruction, even in the absence of predisposing conditions.

Main Methods:

• Case report of a 51-year-old female with acute abdominal pain and vomiting.
• Diagnostic workup included radiologic imaging (revealing jejunal thickening) and diagnostic laparoscopy.
• Pathologic examination of resected jejunal segments confirmed segmental small bowel xanthomatosis.

Main Results:

• Radiologic findings suggested foreign body obstruction due to jejunal loop thickening and inflammatory changes.
• Laparoscopy identified two strictures within the jejunum.
• Histopathological analysis confirmed the diagnosis of segmental small bowel xanthomatosis.

Conclusions:

• Small intestinal xanthomatosis is an uncommon cause of bowel obstruction.
• This case underscores that xanthomatosis can cause obstruction even without associated hyperlipidemia or lymphoproliferative disorders.
• Awareness of rare etiologies like xanthomatosis is crucial for timely diagnosis and management of small bowel obstruction.