209 Giant Mesenteric Lipoma: an atypical presentation of an unlikely hero
Robert Mitchell, Faddy Kamel, Robert Hagger, Kunal Patel- Surgery
Abstract
Background
Mesenteric lipoma’s are a rare and benign mesenchymal tumour originating from mature adipocytes within the gastrointestinal tract. In most cases, they do not cause symptoms. A search of English literature revealed less than 100 reported cases. In those who are symptomatic, presenting symptoms are variable. We present an unusual case of a mesenteric lipoma aiding in the diagnosis of a colorectal cancer.
Case report
A 77 year old lady presented to her GP with chronic abdominal pain. On examination she appeared to have lost weight. Her initial investigations showed a new anaemia. Her FIT was negative. A CT Colon showed a 3.5cm flat lesion in the caecum. Histology, obtained via colonoscopy, proved this to be an Adenocarcinoma. The patient underwent a Laparoscopic converted to open right hemicolectomy. Intraoperatively the caecum was found in the pelvis with a pedunculated lipoma originating from the mesentery overlying the ileocolic artery. Post-operative histology showed a fully resected Adenocarcinoma as well as a 200mmx90mmx20mm giant mesenteric lipoma.
Discussion
We hypothesis that this patient’ presenting symptom of abdominal was unlikely to be due to the colorectal cancer. It is feasible that her pain was secondary to the compressive effect of the lipoma on the caecum and terminal ileum. Without symptoms, it is unlikely the patient would have presented to her GP and the malignancy would likely not have been found at such an early (and resectable) stage.
Conclusion
The mesenteric lipoma was likely the unsung hero for this patient.