Capsule Endoscopy by: Given Imaging

Capsule Endoscopy by: Given Imaging

Submucosal mass-lipoma 


Date:
11/12/2010 
Courtesy Of:
Dr. Glen Arluk 

Patient History

 

Reason for Referral:

A 55 year old male presented with a two year history of intermittent left upper quadrant abdominal pain. The pain would come on at random or associated with exercise.  It was described as a squeezing pain that would last at least thirty minutes and up to two hours.  He would have nausea and vomiting associated with the pain but would be asymptomatic in between episodes.  He denied any weight loss or change in bowel movements.  An EGD and colonoscopy were performed which were normal.  A capsule endoscopy was performed to rule out a possible small bowel lesion.

Gastric Passage Time: 0h 43m

Small Bowel Passage Time: 4h 29m

 

Procedure Info and Findings:

After obtaining informed consent, including the risks of capsule retention, the patient swallowed the capsule without difficulty. The preparation was adequate, and the study completed without complication. A full examination of the small bowel was completed.

 

Previous Diagnostic Findings

 

Findings:

In the proximal jejunum there was a moderately sized pedunculated submucosal mass with a very large stalk.  The overlying mucosa appeared normal without ulceration.  It appeared to be soft and pliable with peristalsis, suspicious for a small bowel lipoma.  The remainder of the examination was completely normal.

Patient Management and Follow-up

 

Summary and Recommendations:

Submucosal mass seen via endoscopic characteristics appeared consistent with a small bowel lipoma.  A CT scan did confirm the fatty nature of the tumor.  This was felt to be a lead point for intermittent intussusception as the etiology of the abdominal pain.  The patient was referred for surgery.  At laparotomy there were adhesions around the proximal jejunum.  Within this region of adhesions was a dilated piece of small bowel with adhesions to the mesentery.  This portion of small bowel was resected and a 7.5 x 1.8 cm small bowel lipoma was confirmed histologically.   Since surgery, the patient has not had a return of his presenting abdominal pain. 

Physician:

Glen Arluk M.D.
Assistant Professor of Medicine, Eastern Virginia Medical School
Gastroenterology LTD
Virginia Beach, Virginia, USA

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