Torsion of a Giant Antimesenteric Lipoma of the Ileum: A Rare Cause of Acute Abdominal Pain

Patient: Male, 67 Final Diagnosis: Torsion of a giant antimesenteric lipoma of the ileum Symptoms: Acute abdomen Medication: — Clinical Procedure: En bloc segmental resection with end-to-end anastomosis Specialty: Surgery OBJECTIVE: Rare disease BACKGROUND: Torsion of an intra-abdominal lipoma is rarely the cause of acute abdominal pain. Most of the previously reported cases of intra-abdominal lipoma torsion originated in the mesentery or omentum. However, an antimesenteric lipoma of the ileum with torsion has not been reported before. CASE REPORT: A 67-year-old man presented to the emergency department with acute abdominal pain. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis only showed a giant fat-containing, soft-tissue, intra-abdominal tumor, suspected to be a lipoma. Laparotomy was performed, and the presence of torsion of the antimesenteric lipoma of the ileum was confirmed. Beside tumor resection, en bloc segmental resection of the ileum with end-to-end anastomosis was performed to avoid bowel stricture and obtain tumor-free margins. CONCLUSIONS: CECT is the modality of choice to detect an intra-abdominal lipoma. Urgent surgical intervention should be considered if the symptoms persist and torsion cannot be excluded. If simple excision is not adequate because of poor accessibility of the tumor stalk, en bloc segmental resection with end-to-end anastomosis should be considered.