OVERVIEW
Enterolipitis is a disease of fat necrosis and inflammation of the enterolipids due to torsion of the enterolipids or spontaneous thrombosis of the draining veins. It is a benign, self-limiting disease and a rare cause of abdominal pain. It can occur at any age, with a peak incidence at 40 years of age, and is slightly more common in men than in women.
Questions you may be concerned about
What does “pending evacuation” mean?
Lipodystrophy “pending” means that the disease is suspected but not diagnosed, and imaging tests are needed to further investigate the presence of the disease.
Lipofuscinosis refers to an inflammatory reaction that occurs in the lipofuscinoses of the bowel. It is located in the outer part of the colon and is mainly adipose tissue with blood vessels in the center. Inflammation of this tissue occurs when there is localized obstructive necrosis due to motor torsion, thromboembolism, or inflammatory invasion such as appendicitis.
Because the disease may not have obvious clinical symptoms at the onset, or only localized pain or pressure pain, clinical examination alone can not be fully diagnosed by the disease, but only the existence of the disease is suspected, some doctors will mark “to be scheduled” or “?”. Some doctors will mark it as “pending” or “?”. It is recommended that further imaging and other related tests be performed to determine whether the disease exists.
The disease is benign, no special intervention is needed for mild cases, and if the symptoms are severe, symptomatic treatment can be provided, such as localized infections with obvious manifestations of cephalosporin and other drugs for intervention. If combined with intestinal obstruction, surgery may be required.
Suspected of intestinal lipodystrophy, it is recommended to consult the doctor in time, improve other related examinations to clarify.
Causes
Lipocele is a small protrusion of the colon and cecum distributed along the sides of the colonic band in addition to the rectum, anal canal, and appendix, formed by the plasma membrane and the adipose tissue contained therein, and occasionally seen on the appendix. The intestinal lipodendrites often line the wall of the colon in two rows, one on the inner side of the free colonic band and the other on the outer side of the omental colonic band. The main causes of intestinal lipodendritis are torsion and infarction. The disease is divided into: (1) primary: torsion of the intestinal lipid pituitary or due to spontaneous venous thrombotic ischemia, most often seen in obese patients; (2) secondary: inflammatory reaction of adjacent tissues involving the intestinal lipid pituitary.
Symptoms
Clinical manifestations depend on the location of the lesion of intestinal fat pituitary, abdominal pain sudden onset, confined to the lesion site, can be manifested as fixed or limited abdominal pain, mostly located in the lower abdomen, more intense, less nausea, vomiting, diarrhea and limited peritonitis, no fever. Acute intestinal lipodystrophy is rare, the onset of symptoms is similar to acute appendicitis, and patients are usually obese.
Examination
1. Physical examination: there may be limited pressure pain in the abdomen, and some patients may be able to palpate the mass.
2. Laboratory examination: blood leukocyte count is normal or mildly increased.
3. Imaging examination: X-ray examination has no special performance. Abdominal ultrasound shows an ovoid mass surrounded by a hyperechoic thin layer of peritoneum. Abdominal CT can see ring-like or ovoid low-density fat mass shadow with a diameter of 1.5-3.5cm, which is more sensitive than ultrasound, especially for obese people.
Diagnosis
The disease should be considered based on a history of intestinal fat pendant torsion or spontaneous thrombosis of the draining vein, limited abdominal pressure pain, and occasional palpation of the mass, but no fever or increased white blood cell count. It is difficult to diagnose, and most of the cases are found accidentally during operation. The development of imaging technology has gradually increased the number of non-surgical investigations to confirm the diagnosis.
Treatment
Primary enterolipidosis usually resolves spontaneously within 1 week, and those diagnosed do not require surgery or anti-infective treatment. If the symptoms are severe enough to require surgical treatment, the root of the lesion should be completely excised, the artery should be ligated, and the plasma membrane layer should be embedded.