Case of simultaneous diverticulosis, lipomatosis and volvulus of the small intestine

Abstract

Two cases of diverticulosis and lipomatosis of the small intestine have been reported'.'. One of these cases had a small bowel volvulus. We report a further case that includes a volvulus. Case reportA 56-year-old man presented with a 4-month history of bouts of postprandial epigastric pain, with intermittent swelling in the right hypochondrium. Pain occurred on eating; he had lost 10 kg in weight. On examination, he was tender in the epigastrium and right hypochondrium.An abdominal ultrasound was normal. Gastroscopy revealed a small area of non-specific superficial gastritis; the barium enema was normal, as was colonoscopy. A small bowel enema showed multiple diverticula and intraluminal polyps throughout the jejunum and ileum (Figure 1 ). At laparotomy, there was a 360" clockwise volvulus of the small bowel, without evidence of vascular compromise. After derotation a length of abnormal small bowel was noted. It began 50cm from the duodenojejunal flexure and extended to 90 cm from the ileocaecal valve. It was thickened and dilated throughout its length. There were numerous large diverticula, up to 7cm in diameter, on both the mesenteric and antimesenteric borders. Multiple polyps could be palpated in this segment, one of which was producing an intussusception. The whole of the affected segment was resected and end-to-end anastomosis was performed. He made an uneventful postoperative recovery.At histological examination multiple discrete submucosal lipomata were found, some at the base of a diverticulum. DiscussionThe occurrence of the diverticulosis and lipomatosis together could occur by chance. The incidence of small bowel diverticulosis is generally reported as being between 1 and 1.5 per cent. Benign small bowel tumours are relatively rare, although lipomata are one of the more common types3. However, the lipomata may have caused a n intermittent or incomplete obstruction encouraging the development of pulsion Volvulus is a recognized complication of small bowel diverticulosis5. The abnormal weight distribution of the bowel may be a factor in its occurrence. We suggest that diverticulosis, lipomatosis and small bowel volvulus are linked, with lipomatosis being causative in the development. 3. References 4.5 .

Jejunal Lipomatosis with Diverticulosis: Report of a Case

“…23 Climie and Wylin 2 reported two cases of lipomatosis and reviewed 16 previously reported cases. Subsequently, we documented six cases [3][4][5]22 and reviewed a total of 23 cases including our own. The age distribution ranged from 20 to 88 years, with a mean age of 50.7 years (n ϭ 22).…”

Lipomatosis of the Jejunum with Volvulus: A Case Report

“…Relatively higher prevalence of diverticulosis among patients with lipomatosis has been reported in previous studies (3,(5)(6)(7).…”

“…Although the muscularis propria is usually unaffected, lipomatosis in the submucosal layer can play a contributory role in the development of diverticulosis by weakening the bowel wall (3,7). Furthermore, lipomatosis may cause intermittent or incomplete obstruction and increase intraluminal pressure, which encourages the development of pulsion diverticulae (7).…”

Lipomatosis of the ileum with volvulus: Report of a case

“…8 Lipomatosis may have weakened the bowel wall, as shown by the attenuation of the muscle layer over the lipomata, and the fact that lipomatosis and diverticulosis occurred together. 8 Lipomatosis may have weakened the bowel wall, as shown by the attenuation of the muscle layer over the lipomata, and the fact that lipomatosis and diverticulosis occurred together.…”

“…The pain was severe and Reprint requests to: H. Abe (Received for publication on Jan. 8,1997; accepted on July 8,1997) had gradually increased in the lower abdomen. The pain was severe and Reprint requests to: H. Abe (Received for publication on Jan. 8,1997; accepted on July 8,1997) had gradually increased in the lower abdomen.…”