Özefagustan rektuma gastrointestinal lipomların çok kesitli bilgisayarlı tomografi (MDBT) bulguları

Öz

Giriş ve Amaç: Gastrointestinal sistemde değişik lokasyonlarda saptanan submukozal lipomların çok kesitli bilgisayarlı tomografi bulgularını değerlendirmek. Gereç ve Yöntem: Bu çalışmaya 2007-2016 tarihleri arasında gastroenteroloji ve genel cerrahi kliniklerinden değişik nedenlerle gönderilen ve abdomen bilgisayarlı tomografisi çekilen 47 hasta dahil edildi. Hastaların 21’i erkek, 24’ü kadın idi. Ortalama yaş 62,64 ± 11.82 (medyan 69.5, aralık 37-81) idi. Hastaların başlıca şikayeti abdominal ağrı, distansiyon, halsizlik ve kabızlıktı. Bütün hastalar kontrastlı veya kontrastsız çok kesitli bilgisayarlı tomografi ile değerlendirildi. Görüntüler 64 kesitli çok kesitli bilgisayarlı tomografi cihazı ile elde edildi. Hounsfield ünitesi olarak kitlelerin dansite ölçümleri yapıldı ve çok kesitli bilgisayarlı tomografi bulguları özetlendi. Bulgular: Toplam 47 hastada lipoma saptandı. Özofagusta 1 (%2.1), midede 4 (%8.5), duedonumda 2 (%4.2), jejenumda 5 (%1.0), ileumda 3 (%6.3), çekumda 9 (%19.1), çıkan kolonda 9 (%19.1), transvers kolonda 4 (%8.5), inen kolonda 5 (%1.0), sigmoid kolonda 4 (%8.5) ve rektumda 1 (%2.1) lipom olgusu vardı. Lipomaların ortalama Hounsfield dansite değeri -93±10,5 (median 85, aralık -70 ile -100) idi. Ortalama en büyük tümör çapı 23 mm ± 18. 5 (median 20, aralık 12 ile 50 mm) idi. Tüm lezyonlar submukozal yerleşimli idi. Sonuç: Gastrointestinal trakt lipomaları özefagustan rektuma kadar herhangi bir yerde izlenebilir. Çok kesitli bilgisayarlı tomografi tanı, lokalize etme ve tanımlama açısından endoskopik biyopsinin minimal ya da hiç yardımı olmaksızın faydalı bir görüntüleme yöntemidir.

Anahtar Kelimeler

• Lipom,MDBT,Gastrointestinal sistem

MDCT findings of gastrointestinal lipomas from esophagus to rectum

Öz

Background and Aims: To evaluate the multidedector computed tomography findings of gastrointestinal lipomas in various locations. Materials and Methods: This study included 45 patients who were referred from the gastroenterology or surgery department over the period of 2007 to 2016. The patients were referred for detailed abdominal examination for various reasons and symptoms. Among the included patients, 21 were males and 24 were females. The mean age of the patients was 62.64±11.82 (median 69.5, range 37-81). The main complaints of the patients were abdominal pain, abdominal distension, tiredness, and constipation. All patients were examined through enhanced or nonenhanced multidedector computed tomography. Imageswere acquired with 64-slice multidedector computed tomography. The densities of the masses were measured in Hounsfield units, and the detailed multidedector computed tomography findings of the masses were summarized. Results: Lipomas were found in 47 patients. Lipomas of the esophagus, stomach, duedonum, jejenum, ileum, and caecum were found in 1 (2.1%), 4 (8.5%), 2 (4.2%), 5 (1.0%), 3 (6.3%), and 9 (19.1%) patients, respectively. Lipomas of the ascending colon, transverse colon, descending colon, sigmoid colon, and rectum were found in 9 (19.1%), 4 (8.5%), 5 (1.0%), 4 (8.5%), and 1 (2.1%) patients, respectively. The lipomas had a mean Hounsfield unit density of −93±10.5 (median 85, range −70-−100). The maximum mean diameter of the lipomas was 23 mm ± 18. 5 (median 20, range 12-50 mm). All lesions were submucosal in location. Conclusion: Lipomas may be located anywhere along the gastrointestinal tract and may be found from the esophagus to the rectum. Multidedector computed tomography is a useful tool for the diagnosis, location, and definition of lesions and does not require or requires minimal assistance from endoscopic biopsy.

Anahtar Kelimeler

• Lipom,MDBT,Gastrointestinal system

Kaynakça

1. References: 1. F. Ferrozzi, G. Tognini, D. Bova, and P. Pavone, “Lipomatous tumors of the stomach: CT findings and differential diagnosis,” J. Comput. Assist. Tomogr. , vol. 24, no. 6, pp. 854–858, Dec. 2000. 2. A. J. Taylor, E. T. Stewart, and W. J. Dodds, “Gastrointestinal lipomas: a radiologic and pathologic review,” Ajr Am. J. Roentgenol. , vol. 155, no. 6, pp. 1205–1210, Dec. 1990. 3. M. J. Ormson, D. H. Stephens, and H. C. Carlson, “CT recognition of intestinal lipomatosis,” Ajr Am. J. Roentgenol. , vol. 144, no. 2, pp. 313–314, Feb. 1985. 4. J. P. Heiken, K. A. Forde, and R. P. Gold, “Computed tomography as a definitive method for diagnosing gastrointestinal lipomas,” Radiology, vol. 142, no. 2, pp. 409–414, Feb. 1982. 5. P. J. Pickhardt, D. H. Kim, C. O. Menias, D. V. Gopal, G. M. Arluk, and C. P. Heise, “Evaluation of submucosal lesions of the large intestine: part 1. Neoplasms,” Radiogr. Rev. Publ. Radiol. Soc. North Am. Inc, vol. 27, no. 6, pp. 1681–1692, Dec. 2007. 6. J. R. Saltzman, D. L. Carr-Locke, and S. A. Fink, “Lipoma case report,” Medgenmed Medscape Gen. Med. , vol. 7, no. 1, p. 16, 2005. 7. G. Karadeniz Cakmak, A. U. Emre, O. Tascilar, S. Bektaş, B. H. Uçan, O. Irkorucu, K. Karakaya, Y. Ustundag, and M. Comert, “Lipoma within inverted Meckel’s diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage: a case report and review of literature,” World J. Gastroenterol. Wjg, vol. 13, no. 7, pp. 1141–1143, Feb. 2007. 8. A. Siegal and M. Witz, “Gastrointestinal lipoma and malignancies,” J. Surg. Oncol. , vol. 47, no. 3, pp. 170–174, Jul. 1991. 9. C. Algin, A. Hacioğlu, T. Aydin, and E. Ihtiyar, “Esophagectomy in esophageal lipoma: report of a case,” Turk. J. Gastroenterol. Off. J. Turk. Soc. Gastroenterol. , vol. 17, no. 2, pp. 110–112, Jun. 2006. 10. Y. Zak, B. Biagini, H. Moore, M. Desantis, and B. C. Ghosh, “Submucosal resection of giant gastric lipoma,” J. Surg. Oncol. , vol. 94, no. 1, pp. 63–67, Jul. 2006. 11. M. Paksoy, D. E. Böler, B. Baca, S. Ertürk, S. Kapan, I. Bavunoglu, and F. Sirin, “Laparoscopic transgastric resection of a gastric lipoma presenting as acute gastrointestinal hemorrhage,” Surg. Laparosc. Endosc. Percutan. Tech. , vol. 15, no. 3, pp. 163–165, Jun. 2005. (12) H. Genchellac, M. K. Demir, H. Ozdemir, E. Unlu, and O. Temizoz, “Computed tomographic and magnetic resonance imaging findings of asymptomatic intra-abdominal gastrointestinal system lipomas,” J. Comput. Assist. Tomogr. , vol. 32, no. 6, pp. 841–847, Dec. 2008. 13. L. Samad, M. Ali, H. Ramzi, and Y. Akbani, “Respiratory distress in a child caused by lipoma of the esophagus,” J. Pediatr. Surg. , vol. 34, no. 10, pp. 1537–1538, Oct. 1999. 14. C. -Y. Wang, H. -S. Hsu, Y. -C. Wu, M. -H. Huang, and W. -H. Hsu, “Intramural lipoma of the esophagus,” J. Chin. Med. Assoc. Jcma, vol. 68, no. 5, pp. 240–243, May 2005. 15. E. M. Marom and P. C. Goodman, “Double-ring esophageal sign: pathognomonic for esophageal lipomatosis,” J. Comput. Assist. Tomogr. , vol. 26, no. 4, pp. 584–586, Aug. 2002. 16. M. Zameer, R. P. Kanojia, K. L. N. Rao, P. Menon, R. Samujh, and B. R. Thapa, “Gastric lipoma,” J. Indian Assoc. Pediatr. Surg. , vol. 15, no. 2, pp. 64–66, Apr. 2010. 17. A. M. Lacy, J. Tabet, L. Grande, J. C. García-Valdecasas, J. Fuster, S. Delgado, and J. Visa, “Laparoscopic-assisted resection of a gastric lipoma,” Surg. Endosc. , vol. 9, no. 9, pp. 995–997, Sep. 1995. 18. W. M. Thompson, A. I. Kende, and A. D. Levy, “Imaging characteristics of gastric lipomas in 16 adult and pediatric patients,” Ajr Am. J. Roentgenol. , vol. 181, no. 4, pp. 981–985, Oct. 2003. 19. S. H. Park, J. K. Han, T. K. Kim, J. W. Lee, S. H. Kim, Y. I. Kim, B. I. Choi, K. M. Yeon, and M. C. Han, “Unusual gastric tumors: radiologic-pathologic correlation,” Radiogr. Rev. Publ. Radiol. Soc. North Am. Inc, vol. 19, no. 6, pp. 1435–1446, Dec. 1999. 20. A. Pezzoli, M. Pennazio, N. Fusetti, L. Simone, A. Zelante, V. Cifalà, T. Sprujevnik, A. Carella, and S. Gullini, “Occult intestinal haemorrhage due to lipoma of the small bowel detected with the combined use of the new endoscopic techniques. A report of two cases,” Dig. Liver Dis. Off. J. Ital. Soc. Gastroenterol. Ital. Assoc. Study Liver, vol. 40, no. 4, pp. 306–309, Apr. 2008. 21. T. Tsushimi, N. Matsui, H. Kurazumi, Y. Takemoto, K. Oka, A. Seyama, and T. Morita, “Laparoscopic resection of an ileal lipoma: Report of a case,” Surg. Today, vol. 36, no. 11, pp. 1007–1011, 2006. 22. S. Kiziltaş, E. Yorulmaz, B. Bilir, F. Enç, and I. Tuncer, “A remarkable intestinal lipoma case,” Ulus. Travma Ve Acil Cerrahi Derg. Turk. J. Trauma Emerg. Surg. Tjtes, vol. 15, no. 4, pp. 399–402, Jul. 2009. 23. S. R. Jai, F. Bensardi, F. Chehab, D. Khaiz, and A. Bouzidi, “Jejunal lipoma with intermittent intussusception revealed by partial obstructive syndrome,” Saudi J. Gastroenterol. Off. J. Saudi Gastroenterol. Assoc. , vol. 14, no. 4, pp. 206–207, Oct. 2008. 24. A. M. Bahadursingh, P. L. Robbins, and W. E. Longo, “Giant submucosal sigmoid colon lipoma,” Am. J. Surg. , vol. 186, no. 1, pp. 81–82, Jul. 2003. 25. L. A. Dultz, B. W. Ullery, H. H. Sun, T. L. Huston, S. R. Eachempati, P. S. Barie, and J. Shou, “Ileocecal valve lipoma with refractory hemorrhage,” Jsls J. Soc. Laparoendosc. Surg. Soc. Laparoendosc. Surg. , vol. 13, no. 1, pp. 80–83, Mar. 2009. 26. K. Atila, C. Terzi, F. Obuz, T. Yilmaz, and M. Füzün, “Symptomatic intestinal lipomas requiring surgical interventions secondary to ileal intussusception and colonic obstruction: report of two cases,” Ulus. Travma Ve Acil Cerrahi Derg. Turk. J. Trauma Emerg. Surg. Tjtes, vol. 13, no. 3, pp. 227–231, Jul. 2007. 27. P. Katsinelos, G. Chatzimavroudis, C. Zavos, I. Pilpilidis, G. Lazaraki, B. Papaziogas, G. Paroutoglou, J. Kountouras, and D. Paikos, “Cecal lipoma with pseudomalignant features: a case report and review of the literature,” World J. Gastroenterol. Wjg, vol. 13, no. 17, pp. 2510–2513, May 2007. 28. Krishnan P, Adlekha S, Chadha T, Babu A. Rectal lipoma associated with genital prolapse. Ann Med Health Sci Res. 2013 Nov;3(Suppl 1):S18-20. doi: 10. 4103/2141-9248. 121212. PubMed PMID: 24349839; PubMed Central PMCID: PMC3853598.