small intestinal lipoma
Introduction
Introduction to small intestinal lipoma Small intestinal lipoma is a benign tumor derived from the submucosal or subserosal adipose tissue of the small intestine. It occurs mostly in the ileum and is polypoid, nodular or invasive. The general prognosis is good. basic knowledge The proportion of illness: 0.035% Susceptible people: no specific population Mode of infection: non-infectious Complications: gastrointestinal bleeding, intussusception, intestinal torsion
Cause
Causes of small intestinal lipoma
(1) Causes of the disease
Small intestinal lipoma mainly comes from the submucosal layer of the intestinal wall. It generally does not grow very long. It looks like fatoma in other parts of the body and is composed of mature adipose tissue.
(two) pathogenesis
1. Good hair
Intestinal lipoma is most common in the ileum. The order of domestic hair growth is ileum (50%-60%), jejunum (23.8%), duodenum (13.2%); foreign ileum, duodenum, jejunum The proximal jejunum of the proximal trochanteric ligament and the terminal ileum of the proximal ileocecal area are the predilection sites of small intestinal lipoma.
2. Pathology
Small intestinal lipoma mainly comes from the submucosal layer of the intestinal wall, protruding into the intestinal lumen, such as polypoid or sputum umbrella, some can be pedicled, small volume; can also occur under the serosa, protruding beyond the intestinal wall, volume can be The tumor can be single or multiple, the multiple lesions such as polyposis are distributed in the whole small intestine, the polyps are only a few centimeters apart, and the growth pattern of lipoma is in four forms: single-shot limited mass, multiple and Dispersed mass, multiple fat nodules fused together, adipose tissue infiltrated in the submucosa without forming tumor-like nodules, small intestinal lipoma composed of mature adipose tissue, spherical in appearance, yellow, soft and limited Tumor, there is a layer of intact thin connective tissue outer membrane, the surface of the tumor may be erosive, necrotic or shallow ulcer formation, the cut section may appear bulge, the tissue lobes are irregular in size, pale yellow, with oily luster .
The structure under the microscope is indistinguishable from normal adipose tissue. The main difference is whether or not there is a capsule. The biopsy is based on only one piece of tissue. It is difficult to make a correct diagnosis. It is necessary to refer to the observation of the gross specimen. The tumor composition is composed of mature fat cells of the same size. Mainly, sometimes there are tumor cells like yellow tumors, and more or less irregularly distributed connective tissue interstitial. The intestinal wall near the tumor may have different degrees of congestion and inflammatory cell infiltration.
3. Pathological typing
According to the location and growth pattern of small intestinal lipoma, it can be divided into four types:
(1) intraluminal type: this type of lipoma is limited to the mucosal surface, and protrudes into the intestine, some of which can be pedicled, this type is the most common, accounting for more than 90%, because it is easy to cause intestinal obstruction, intestine It is easy to find complications such as stacking and bleeding, and the volume is relatively small.
(2) Extraluminal type: Anyone who grows outside the cavity belongs to this type, and is more common in lipomas that occur under the serosal membrane. It is less common, and some people account for 3.2%. Smaller subserosal exogenous lipoma is easy. Cause bowel twist, pain, obstruction and other symptoms.
(3) Intestinal wall type: the tumor does not protrude to the inside and outside of the intestine, but only in the intestinal wall, accounting for 5.5%. This type of lipoma is often small, round or oval, causing less symptoms and ringing. Growing intestinal wall lipoma easily causes intestinal stenosis and obstruction.
(4) Mixed type: Different combinations of the above three cases, the symptoms of this type of lipoma have different manifestations due to the mixing of different situations.
Prevention
Intestinal lipoma prevention
1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.
2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.
Complication
Complications of small intestinal lipoma Complications, digestive tract bleeding, intussusception
1. Gastrointestinal hemorrhage: The bleeding is intermittent, mainly manifested as blood in the stool. The amount of bleeding is generally small. Most of them are only positive for fecal occult blood test. A few can be tar-like stools, dark red loose stools, often accompanied by anemia.
2. Intussusception: Because the tumor grows in the intestinal lumen, the intestinal tract is not fully obstructed, which stimulates the intestinal tube to contract strongly, and the peristaltic rhythm of the intestinal wall is disordered, and the intestinal tube of the tumor is nested.
Intussusception, intestinal torsion, and perforation of the intestinal wall are complications of small intestinal lipoma and are the main cause of treatment.
Symptom
Symptoms of small intestinal lipoma Common symptoms Abdominal gastrointestinal bleeding Bleeding abdominal discomfort Abdominal mass nausea dull pain Peritonitis Acute intestinal torso intussusception
General symptoms
Generally, there are no obvious symptoms. Some patients can be asymptomatic for life. They are only found during other operations or autopsy in the abdomen. In cases with clinical manifestations, they have different manifestations due to different pathological types of tumors, generally showing abdominal pain. Gastrointestinal hemorrhage, chronic intestinal obstruction, abdominal mass, etc., 50% are treated with intussusception, and the lipoma of the ileocecal submucosa, also known as lipomatosis, is not easy to be used in X-ray examination. The difference in cecal cancer is also prone to intussusception.
1. Abdominal pain: mostly intermittent seizures, showing dull or dull pain, abdominal discomfort, recurrent attacks, abdominal pain can be located in the upper abdomen, umbilical or lower abdomen, when there is incomplete obstruction, there may be severe pain in the umbilical cord, accompanied by There are symptoms such as nausea, vomiting, and bloating.
2. Gastrointestinal hemorrhage: more common, mainly due to necrosis on the surface of the tumor, ulcer formation, bleeding is intermittent, mainly manifested as blood in the stool, the amount of bleeding is generally small, mostly only for fecal occult blood test positive, a few can be tar-like However, dark red loose stools, often accompanied by anemia symptoms, a large amount of bleeding in the upper part of the jejunum can also have hematemesis, a case of a 48-year-old male patient, a sudden vomiting blood 600ml within two days, emergency laparotomy pathological diagnosis of jejunal multiple Sexual lipoma, in the clinical small intestine multiple lipoma with a large number of gastrointestinal bleeding is rare.
3. Intussusception: due to the tumor in the intestinal lumen, the intestine is not fully obstructed, stimulates the intestinal tube to contract strongly, sputum, intestinal wall motility rhythm disorder, and the tumor in the intestine tube is nested, the tumor is often in the intussusception In the middle or at the top, the lump mass can be touched on the abdomen and the obstruction symptoms can occur. The type of the nesting can be back-return type, air-empty type, back-knot type, back-back-junction type.
4. Abdominal mass: Sometimes the lumps grow larger than the outside of the cavity, can touch the abdominal mass, and have tenderness, the lumps have a large degree of activity, and the intussusception can also reach the nested mass.
5. Intestinal torsion: due to the effect of gravity on the surface of the serosal surface, it can cause intestinal torsion and cause strangulated intestinal obstruction, or due to intestinal obstruction, intussusception, causing intestinal necrosis, perforation of the intestinal wall, and peritonitis .
Examine
Examination of small intestinal lipoma
1. Blood routine examination: When the tumor is repeatedly bleeding, there may be small cell anemia.
2. Fecal occult blood test: can be positive.
3. Histopathological examination: visible to the naked eye is bright yellow, round, with envelope, convex to the mucosal surface, the diameter is more than a few centimeters, polypoid, no pedicle or pedicle, cut surface lobulated, yellow, there Greasy luster, microscopic examination, the tumor consists of differentiated mature fat cells with irregularly distributed connective tissue interstitium.
4. Double contrast of gas sputum: double angiography of digestive tract can reveal a round or oval lumps in the intestine, which is lobulated or smooth, clear boundary, high transmittance, and its shape can be changed by local pressure. It can also have deep ulcers, and can prompt signs of intestinal obstruction and intussusception.
5. Endoscopy: often manifested as pedunculated or pedunculated submucosal bulging lesions, smooth surface or superficial ulcer, because small intestinal lipoma is submucosal lesions, endoscopic biopsy is often negative.
6.B-ultrasound examination: the normal small intestine sonogram is usually mixed with gas, mucus and liquid due to the different contents contained in different segments of the intestine. The thickness of the intestine wall in the filling state is about 3.0mm, generally not More than 5.0mm, suspected intestinal wall thickening or found a mass, need to drink about 500ml to continue to check, every 10 to 15min repeated, small intestinal lipoma can present three kinds of sonographic features under B-ultrasound: intraluminal mass , intra-wall type and extraluminal mass type.
7. CT examination: can determine the tumor location, size, etc. CT image features: the tumor has a homogeneous fat density shadow, the boundary is clear, the image is not enhanced after the injection of contrast, and the intussusception is inhomogeneous soft tissue shadow, showing the target shape Or sausage shape.
8. MRI examination: The signal characteristic is that the fat component of the T1 weighted image is a high signal, and the T2 weighted image is also a high signal. As the echo time is prolonged, the signal intensity gradually decreases.
9. Selective mesenteric angiography: help to identify the lesion and the nature of the lesion, especially in the active bleeding period, only need 0.5ml of bleeding per minute to give a positive result.
10. Exploratory laparotomy: For suspected intestinal tumors or palpation of sputum and masses, and no lesions were found in each examination, laparotomy was performed to confirm the diagnosis and remove the lesions.
Diagnosis
Diagnosis and diagnosis of small intestinal lipoma
diagnosis
Small intestinal lipoma is asymptomatic in the early stage, and symptoms may appear in the late stage due to complications such as intestinal obstruction and hemorrhage, but lack of specificity, diagnosis is quite difficult, and X-ray, CT, histopathology and other examinations are needed to assist diagnosis.
Diagnose based on
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
3. Exploratory laparotomy: For suspected intestinal tumors or palpation of sputum and masses, and no lesions were found in each examination, laparotomy was performed to confirm the diagnosis and remove the lesions.
Differential diagnosis
Should be differentiated from peptic ulcer bleeding, small intestine adenoma, inflammatory polyps and other diseases.
Duodenal ulcer
Can also have abdominal pain, gastrointestinal bleeding, nausea, vomiting, abdominal distension and other symptoms, in addition to the above performance can also cause pyloric obstruction symptoms, need to be differentiated from duodenal tumor, by X-ray examination, angiography, duodenoscope The examination of the histological examination is distinguishable and, if necessary, surgical exploration is required to confirm the diagnosis.
Enteral tuberculosis
Intestinal tuberculosis may have abdominal pain, diarrhea or constipation, lumps and other manifestations, sometimes easily mistaken for cancer, but intestinal tuberculosis is accompanied by fever, night sweats and other tuberculosis toxemia, and often accompanied by extraintestinal tuberculosis, gastrointestinal X-ray Tincture examination showed signs of irritability, filling defects or stenosis in the ileocecal area. There were ulcers, stiffness, and stenosis in the lesions of the colonoscopy. The biopsy revealed typical tuberculosis lesions - cheese-like granuloma, anti-tuberculosis treatment. Effective, can be identified with small intestine tumors.
