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      A systematic review of symptomatic small bowel lipomas of the jejunum and ileum

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          Abstract

          Introduction

          Small bowel lipomas are rarely encountered benign adipose growths found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. We aim to aid clinical decision-making and improve patient outcomes through this comprehensive review.

          Methodology

          The terms ‘small bowel,’ ‘small intestine,’ ‘jejunum’ and ‘ileum’ were combined with ‘lipoma.’ EMBASE, Medline and PubMed database searches were performed. All papers published in English from 01/01/2000-31/12/2019 were included. Simple statistical analysis ( t-test, Anova) was performed.

          Results

          142 papers yielded 147 cases (adults = 138, pediatric = 9). Male = 88, female = 59 (average age = 49.9 years). Presenting symptoms: abdominal pain = 68.7%; nausea/vomiting = 35.3%, hematochezia/GI bleeding = 33.3%; anaemia = 10.9%; abdominal distension = 12.2%; constipation = 8.9%; weight loss = 7.5%. Mean preceding symptom length = 58.1 days (symptoms >1 year excluded (n = 9)). Diagnostic imaging utilised: abdominal X-Ray = 33.3%; endoscopy = 46.3%; CT = 78.2%; ultrasound = 23.8%. 124/137 (90.5%) required definitive surgical management (laparotomy = 89, laparoscopcic = 35). 9 patients were successfully managed endoscopically. Lipoma location: ileum = 59.9%, jejunum = 32%, mesentery = 4.8%. Maximal recorded lipoma size ranged 1.2–22 cm.

          Mean maximum lipoma diameter and management strategy comparison: laparotomy 5.6 cm, laparoscopic = 4.4 cm, endoscopic = 3.7 cm, conservative = 4.5 cm. One-way Anova test, p value = 0.21. Average length of stay (LOS) was 7.4 days (range = 2–30). T-test p value = 0.13 when comparing management modalities and LOS. 4 complications, 0 mortality.

          Conclusions

          Important previously undocumented points are illustrated; a clearer symptom profile, diagnostic investigations utilised, size and site of lipomas, types and effectiveness of management modalities, associated morbidity and mortality. Open surgery remains the primary management. No statistically significant difference in LOS and lipoma size is demonstrated between management strategies. Endoscopic and laparoscopic techniques may reduce utilising invasive surgery in the future as skillset and availability improve.

          Highlights

          • Up to date overview of symptomatic lipomas of the jejunum and ileum which no other paper has previously covered.

          • Highlights associated symptom profile, investigations, site and size of symptomatic lipomas, morbidity and mortality.

          • Evaluates the effectiveness of management strategies.

          • Offers a practical summary that may help guide other clinicians faced with similar presentations in the future.

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          Most cited references35

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          The diagnosis and management of adult intussusception.

          While intussusception is relatively common in children, it is a rare clinical entity in adults, where the condition is almost always secondary to a definable lesion. Thirteen cases of intussusception occurring in individuals older than 16 were encountered at our institute between 1981 and 1994. Presenting signs/symptoms included recurrent bowel obstruction, intermittent pain, and red blood per rectum. Correct preoperative diagnosis was made in six patients using colonoscopy, flexible sigmoidoscopy, upper gastrointestinal (GI) series and computed tomography (CT). At surgery the lead point was identified in the small intestine in eight cases, in the colon in four cases, and one small intestinal intussusception was considered idiopathic. Twelve patients underwent laparotomy and one patient was both diagnosed and treated by colonoscopy alone. Adult intussusception is an unusual cause of bowel obstruction. The likelihood of neoplasia, particularly in the colon as a cause, is high. Operative management is thus almost always necessary.
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            Colonoscopic perforation: incidence, risk factors, management and outcome.

            This review discusses the incidence, risk factors, management and outcome of colonoscopic perforation (CP). The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions. The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities. Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases. Current therapeutic approaches include conservative management (bowel rest plus the administration of broad-spectrum antibiotics), endoscopic management, and operative management (open or laparoscopic approach). The applications of each treatment are discussed. Overall outcomes of patients with CP are also addressed.
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              Tumor spectrum of adult intussusception.

              Adult intussusception is rare. Most general and colorectal surgeons are unfamiliar with its etiology and optimal management. Patients older than 16 years and diagnosed with intestinal intussusception between January 1990 and June 2006 were retrospectively reviewed. Data related to presentation, diagnosis, treatment, and pathology were analyzed. Seventy-two patients underwent surgery for intestinal intussusception. Neoplasm was identified as the cause of intussusception in 66 (92%) cases, and 6 (8%) were idiopathic. The incidence of malignant colonic intussusception (63%) was significantly higher than that of enteric intussusception (20%), P = 0.001. Primary colon adenocarcinoma (8 of 10 patients, 80%) and malignant lymphoma (2 of 10 patients, 20%) were the two most common underlying malignant lesions in the colon. Lipoma (15 of 40 patients, 38%) and Peutz-Jegher adenoma (10 of 40 patients, 25%) were the two most common lesions of benign small bowel neoplasms while 27% (3 of 11) of malignant enteric intussusception cases were malignant lymphoma and metastatic respectively. Lipoma is the most common benign tumor in both small and large bowel intussusception. Whereas 80% of tumors associated with small bowel intussusception were benign, two-thirds of colonic intussusceptions had resulted from primary adenocarcinoma. (c) 2008 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                Elsevier
                2049-0801
                01 September 2020
                October 2020
                01 September 2020
                : 58
                : 52-67
                Affiliations
                [1]West Hertfordshire Hospitals NHS Trust, Vicarage Rd, Watford, Hertfordshire, WD18 0HB, UK
                Author notes
                []Corresponding author. nickfarkas@ 123456doctors.org.uk
                Article
                S2049-0801(20)30274-0
                10.1016/j.amsu.2020.08.028
                7486416
                32953101
                e3c3471b-028e-43ac-95f9-8baad77fbb61
                © 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 11 August 2020
                : 17 August 2020
                : 19 August 2020
                Categories
                Systematic Review / Meta-analysis

                lipoma,small bowel,small intestine,jejunum,ileum
                lipoma, small bowel, small intestine, jejunum, ileum

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