Late Ileocolic Anastomotic Stricture Due to Subserosal Lipoma: A Case Report

Anastomotic strictures after ileocolic surgery are most often related to technical, ischemic, or inflammatory factors, with tumor recurrence also in the differential; a subserosal lipoma arising at the anastomosis is rare. We report a man in his 60s, 10 years after an ileocecal resection for appendicitis with abscess, who presented with right-sided abdominal pain and repeated vomiting. Contrast-enhanced CT demonstrated small-bowel wall hyperenhancement with fluid retention and a tight narrowing at the ileocolic anastomosis. After stabilization, colonoscopy showed edematous, ulcerated mucosa and a non-traversable stricture; biopsies revealed only inflammatory changes. Fluoroscopic balloon dilation was attempted, but guidewire cannulation failed, and conservative management was judged unlikely to succeed; therefore, the anastomotic segment was resected. Gross examination revealed compression of the bowel wall by subserosal adipose tissue with blunting of mucosal folds. Histology showed nodular proliferation of mature adipocytes in the subserosa without atypia or lipoblasts, consistent with a benign subserosal lipoma. Recovery was uneventful, and the patient was discharged on postoperative day 15. This case highlights subserosal lipoma at an ileocolic anastomosis as an uncommon cause; when endoscopic passage is impossible and imaging suggests an extraluminal fatty component, early surgery should be considered.