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- W2979287889 abstract "Introduction: Colonic lipomatosis is a rare benign disease encountered in clinical practice. It presents as localized or diffuse lipomatous submucosal infiltration. We herein present a case of diffuse colonic lipomatosis that was misinterpreted on computed tomography (CT) as pneumatosis coli suggestive of ischemia. Case Report: A 79-year-old male was admitted with multiple rib fractures and compression fracture of the seventh dorsal vertebra after multiple falls secondary to seizures. Fractures were treated conservatively and patient was receiving opioids for pain control. On the third hospitalization day, the patient started to have increasing abdominal pain with vomiting, distention, and constipation. Vital signs were stable. Abdominal exam showed distended, tender abdomen, without peritoneal signs. Bowel sounds were hypoactive. Abdominal series revealed distended right side large bowel. CT scan of the abdomen with intravenous and rectal contrast showed markedly dilated large bowel loops ranging from more prominent at transverse colon, with right hemicolon wall pneumatosis suggestive of bowel ischemia. There was no mechanical obstruction or perforation (Figure 1A). Because of the remarkable distension causing possible early large bowel ischemia, colonoscopy was attempted cautiously for colonic decompression. However, during the procedure at the level of transverse colon, both blood pressure and heart rate dropped and the procedure was aborted. Mucosa appeared normal up to the area examined. Subsequently the patient’s abdominal distention and pain continued to worsen and he became hemodynamically unstable. Therefore, he underwent exploratory laparotomy, which revealed massively distended viable large bowel extending from the cecum, which had a diameter of 15 cm, to the descending colon with a decrease of the luminal diameter at the sigmoid colon. Right hemicolectomy with end ileostomy was performed. Postoperative course was uneventful. Histopathology showed massive and diffuse submucosal colonic lipomatosis (Figures 1B and 1C).Figure 1: (A) Abdominal CT scan shows severe colonic distention and right colon wall pneumatosis. (B) Photomicrograph showing diffuse infiltration of fat within the submucosa and above the muscularis propria (H & E, x 20). (C) Photomicrograph showing oil red stain highlighting the transmural adipocytes present within the submucosa (H & E, x 20).Conclusion: Differentiating colonic lipomatosis from pneumatosis without histological exam can be challenging." @default.
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- W2979287889 date "2014-10-01" @default.
- W2979287889 modified "2023-10-18" @default.
- W2979287889 title "Colonic Lipomatosis Mimicking Pneumatosis Coli" @default.
- W2979287889 doi "https://doi.org/10.14309/00000434-201410002-01409" @default.
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