A 60-year-old man presented with a 6-month history of intermittent lower abdominal pain, bloating and constipation. Physical examination was normal and his stool tested negative for occult blood. A barium enema obtained 2 months before was reportedly normal. Colonoscopy revealed a large mass in the cecum at the ileocecal valve
(A). Biopsy specimens showed only hyperplastic tissue. The patient underwent a limited resection of the cecum and terminal ileum. Pathologic examination of the surgical specimen
(B) revealed a 5 × 4.5 cm submucosal lipoma of the terminal ileum located 2.5 cm proximal to the ileocecal valve. The large ileal lipoma presumably had been prolapsing intermittently through the ileocecal valve causing transient obstruction. The patient has had no further symptoms at 2 years after surgery.
David M. Felig, MD
Hackensack University Medical Center, Hackensack, New Jersey
Published in issue: Gastrointestinal Endoscopy, Vol. 53, Issue 3, p342, March, 2001