Small bowel volvulus due to a mesenteric lipoma: a case report
Souhaib Atri1, Mahdi Hammami1, Amine Sebai1
1Department of General Surgery A, Hopital La Rabta, Tunis, Tunisia.
Introduction:
Small bowel obstruction is a common surgical emergency, most often caused by adhesions or hernias. Rarely, benign mesenteric tumors, such as lipomas, can act as a fulcrum for volvulus and lead to chronic or acute obstruction.
Case Presentation:
We report on a 63-year-old male with a 2-year history of recurrent subocclusive episodes. Abdominal computed tomography demonstrated a chronic-appearing small bowel volvulus with engorged mesenteric vessels, and magnetic resonance imaging (MRI) confirmed the presence of a 7 cm benign mesenteric lipoma in the right iliac fossa. The patient underwent elective laparotomy, which revealed a chronic volvulus of the jejunum, 2.5 m from the duodenojejunal junction, secondary to the lipoma. Detorsion and complete resection of the mass were performed. Postoperative recovery was uneventful, and histology confirmed a benign lipoma. At 6-month follow-up, the patient remained asymptomatic.
Discussion:
Mesenteric lipomas are rare tumors, typically asymptomatic but may be complicated by volvulus, causing bowel obstruction. Imaging with computed tomography and MRI is essential to establish the diagnosis, confirm the benign nature of the mass, and guide surgical planning. Surgical excision is curative, with an excellent prognosis.
Conclusion:
A mesenteric lipoma should be considered in patients with recurrent, unexplained small-bowel obstruction. Cross-sectional imaging allows accurate diagnosis, and surgical excision provides definitive treatment.
