Intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing gastric cystica profunda component cells within the inverted Meckel’s diverticulum: a case report

Abstract

Background Lipomas are the most common cause of intussusception in adults. To our knowledge, however, no cases of lipoma and ectopic gastric mucosa with gastritis cystica profunda (GCP) have been reported. We report a case of intussusception caused by a small intestinal lipoma with ectopic gastric mucosa containing GCP-component cells within the inverted Meckel’s diverticulum. Case presentation A female in her 40s underwent computed tomography for postoperative follow-up of left breast cancer. A tumor, suspected to be a lipoma, was found in the ileum. Since there were no symptoms, the patient underwent regular follow-up. However, gradual enlargement was observed, and surgery was recommended due to the risk of intussusception. After reduction via the Hutchinson technique, laparoscopically assisted partial resection of the small intestine was performed due to suspicion that the tumor was causing intussusception starting from the ileum. Histopathologic examinations revealed proliferation of mature adipose tissue in the subserosal layer, which was diagnosed as lipoma. Furthermore, adipose tissue was found in the stem area and accordingly, we diagnosed lipoma associated with the inverted Meckel’s diverticulum. Moreover, gastric mucosa-like crypt epithelium and proper glandular tissue were identified in the mucosal membrane at the area of onset, and signs of gastric pit dilatation over the submucosa and crypt epithelium hyperplasia were observed. Diagnosis was ectopic gastric mucosa containing GCP component tissue. Conclusions Intussusception in the small intestine complicated with lipoma and ectopic gastric mucosa with GCP within the Meckel’s diverticulum has not been reported, demonstrating the rarity of our case.

A Pediatric Case of Inverted Meckel’s Diverticulum Presenting with Cyclic Vomiting-like Symptoms: A Case Report and Literature Review

“…In the literature review including the present case, bloody stool was observed in 55/74 (74.3%) of adults and 3/9 (33.3%) of children, with a significant difference ( p = 0.019) ( Table 1 ). Although it may not be sufficient to conclude that the diagnosis of inverted Meckel’s diverticulum is usually delayed in pediatric cases because of the absence of bloody stool, eight pediatric cases, excluding the present case, resulted in ileus due to intussusception, and imaging findings of intussusception were observed significantly more often in children than in adults ( p = 0.001) [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. On the other hand, adult cases may have significantly more anemia due to chronic intestinal hemorrhage ( p < 0.0001) ( Table 1 ), because the adult cases do not present with the acute onset of intussusception, unlike the pediatric cases.…”

“…In total, 94 related articles were retrieved. There were 29 articles for 74 adult [ 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] and 9 pediatric (age < 18 years) [ 2 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] cases including the present case] that reported the course of each case in detail. These included 55 male and 28 female patients with onset ages of 2 to 78 years.…”

Intestinal intussusception of Meckel’s diverticulum, a case report and literature review of the last five years

“…Two patients were less than 6 months of age, ( 6 , 10 ) three between 1 and 6 years of age, ( 14 , 16 , 17 ) five between 15 and 30 years of age ( 5 , 7 , 13 , 18 , 19 ) and five between 40 and 50 years of age. ( 8 , 9 , 11 , 12 , 15 )…”

Jejunal intussusception due to an atypical lipomatous tumor: a rare case report

“…The most common benign lesions acting as lead points of intussusceptions are polyps, adenomatous in colon or Peutz-Jeghers in the small bowel and lipomas. Gastrointestinal lipomas are most frequently found in patients aged 50–70 years [ 1 , 10 ]. Lipomas of the gastrointestinal tract are encountered with decreasing order of frequency in the colon (65–75%), small intestine (20–25%), stomach and esophagus [ 11 ].…”

“…Regarding treatment options, resection is the treatment of choice for adults presenting with symptomatic intussusception [ 1 , 2 , 9 , 10 ]. Partial small bowel resection can either be done by laparotomy or laparoscopy.…”