PMC6000738_01
Preoperative diagnosis of submucosal terminal ileal lipoma. (a) Colonoscopy showed a 1.5 cm subepithelial lesion in terminal ileum. (b) Small bowel series showed a submucosal lesion in terminal ileum (Black arrow). (c) (d) Contrast enhanced CT scan of abdomen showed a hypodense submucosal lesion (white arrow), suspected 1.5 cm lipoma, at distal ileum without ileal obstruction or intussusception.
gr1.jpg
PMC6000738_01_gr1.jpg
fig0005
Then colonoscopy was performed and showed a 1.5 cm diameter subepithelial lesion in terminal ileum (Fig. 1a). Then small bowel series was performed and showed a submucosal lesion at terminal ileum (Fig. 1b). Computed tomography was also arranged and showed a hypodense submucosal lesion (1.5 cm, Hounsfield unit: -61.5) suspected lipoma at distal ileum without ileal obstruction or intussusception (Fig. 1c, d).
Intraoperative minimal invasive surgery of submucosal terminal ileal lipoma. (a) CT-guided patent blue dye injection near the terminal submucosal lesion for localization (white arrow). (b) The submucosal lesion was pulled out of the terminal ileum. (c) The terminal ileotomy was sutured by Dexon 3-0 intracorporeally. (d) The lipoma of 1.5 cm was shown grossly.
gr2.jpg
PMC6000738_01_gr2.jpg
fig0010
The location of needle tip was checked by CT (Fig. 2a) and about 1 cc of patent blue was injected into lesion as pigment mark for localization. The submucosal lesion was seen when entering the lumen of distal ileum and it was externalized out of the ileum (Fig. 2b). Then ileum submucosal defect and ileotomy were sutured by Dexon 3.0 intracorporeally for the lesion very near ileocecal junction (Fig. 2c). The gross specimen was showed (Fig. 2d) and pathology proved lipoma.