Lipomatosis of the ileocecal valve as a cause of acute abdomen in a patient with aplastic anemia

Abstract

Ileocecal region can be affected by many pathological conditions, such as benign and malignant tumors, inflammatory processes (appendicitis, diverticulitis, Crohn’s disease) and infectious diseases, which determines the importance of knowledge of differential diagnosis. Lipomatous lesions in intestine may be single or multiple, encapsulated lipomas or diffuse, discrete, uncapsulated areas of adipose tissue called lipomatosis, occurring in 0.04 to 4.5% of cases according to autopsies and more often affecting the cecum. A case of lipomatosis of the ileocecal valve in a patient with aplastic anemia, manifested by symptoms of an acute abdomen due to massive hemorrhage into it due to severe thrombocytopenia, regarded intraoperatively as a malignant tumor that was not removed due to the high risk of bleeding on the background of severe thrombocytopenia, is presented. Preoperatively, CT scans of the abdominal cavity, retroperitoneal space, and pelvis revealed thickening of the colon walls throughout up to 14 mm with smoothness, straightening of contours, and moderate infiltration of surrounding fiber. In the area of the dome of the cecum, an infiltrate with dimensions of 10,0×6,0 cm, with areas of liquid density, is determined. The diameter of the cecum is 6,0 cm, its walls are sharply thickened to 2.5 cm, the lumen is deformed, narrowed. Retroperitoneal lymph nodes are not enlarged. Finally, the nature of the process was established by histological examination of autopsy material. Intestinal lipomatosis is a rare pathology with nonspecific manifestations from the gastrointestinal tract and certain diagnostic difficulties. It is necessary to remember about its possible presence for inclusion in the differential diagnosis.