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Journal of Postgraduate Medicine, Vol. 57, No. 3, July-September, 2011, pp. 253-255 Letter A giant mesocolic lipoma - presenting as an irreducible sliding inguinal hernia: A case report of a rare clinical presentation AB Pachani, A Reza, RV Jadhav, S Mathews Department of Surgery, M.G.M. Medical College & Hospital, Navi Mumbai, Maharashtra, India Code Number: jp11069 PMID: 21941071 Sir, Lipoma is the most common soft tissue tumor. These slow-growing, benign, fatty tumors, form lobulated soft masses that are enclosed by a thin fibrous capsule. [1] The most common type is the "superficial subcutaneous lipoma", which is just below the surface of the skin. Most lipomas occur on the trunk, thighs and the forearms, although they may be found anywhere in the body where fat is located such as intramuscular, retroperitoneal or gastrointestinal. Lipomas are usually relatively small with diameters of about 1-3 cm, but in rare cases they can grow over several years into "giant lipomas" that are 10-20 cm across and weigh up to 4-5 kg. [2] These tumors can occur at any age, but are most common in middle age, often appearing in fifth and sixth decade of life. A 68 year old gentleman presented with a swelling in left groin region, which was reducible previously and became irreducible since two days. Patient was complaining of dull aching pain accompanied with the swelling. There were no symptoms suggestive of intestinal obstruction. On examination there was a huge inguino-scrotal swelling on left side, which was irreducible and mild tender on palpation. There were no signs of inflammation or strangulation. The patient was admitted with a pre-operative diagnosis of irreducible inguinal hernia, and all routine investigations including X-ray abdomen standing and USG abdomen and pelvis were performed. There were no features of intestinal obstruction or free gas under the domes of diaphragm. USG showed moderate amount of free fluid intraperitoneally and rest of the findings were normal. Patient was operated for the same. Intra operative findings were suggestive of a sliding inguinal hernia by sigmoid colon with a huge mesocolic mass, which reached into the scrotum along with adhered greater omentum [Figure - 1] and [Figure - 2]. Careful dissection was done to separate greater omentum from the mass and mesocolic mass was removed and sent for histopathology, while sigmoid colon was reposited back into the peritoneal cavity. The usual repair was performed. The gross findings were 16Χ12Χ8 cm mass with smooth yellowish lobulated surface [Figure - 3]. Microscopic appearance was suggestive of features of lipoma [Figure - 4]. Lipomas are uncommon tumors in the gastrointestinal tract, and generally gastrointestinal lipomas are submucosal or subserosal. Most of them are asymptomatic, although they may cause vague abdominal pain (71%), nausea and vomiting (68%), abdominal distension with partial obstruction (45%), or palpable abdominal mass at physical examination and rarely gastrointestinal bleeding. [3],[4] Colonic lipomas may induce intussusception. Giant pedunculated lipomas have been associated with intermittent colonic Intussusception. As it is a tumor which arises from primitive and totipotent mesenchymal cells, radical surgery is the only therapeutic option. Only one case we found in the literature of mesocolic lipoma which was reported as "Multiple primitive lipoma of the transverse mesocolon: A rare disease" - in 2006. [5] In conclusion we are trying to report a rare case of very unusual site of lipoma in sigmoid mesocolon in an elderly person who clinically presented to us as an irreducible inguinal hernia, which on surgery was diagnosed as a giant mesocolic lipoma presenting as an irreducible sliding inguinal hernia and is a very rare clinical presentation. References
Copyright 2011 - Journal of Postgraduate Medicine The following images related to this document are available:Photo images[jp11069f2.jpg] [jp11069f4.jpg] [jp11069f3.jpg] [jp11069f1.jpg] |
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