Laparoscopic management of Mesenteric Inflammatory myofibroblastic tumor torsion: a case report
EAES Academy. Lovitskyi Y. 07/05/22; 363091; P136
Ms. Yurii Lovitskyi
Contributions
Contributions
Abstract
Backgroung
Inflammatory myofibroblastic tumors (IMTs), also known as inflammatory pseudotumors are rare type of mesenchymal tumors with malignant potential, the most frequently involved sites are mesentery and omentum. Mesenteric IMTs are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgery. A review of the literature shows that only a relatively small number of mesenteric IMTs complications have been reported.
Case presentation
A 29-year-old female was hospitalized due to fever, localized muscle tenderness and right upper quadrant abdominal pain. The patient mentioned that she has suffered from symptoms for 2 days and had one the same episode in the past. Laboratory studies showed elevated white blood cells count (WBC – 13,2*109/L) and c- reactive protein level (CRP – 120 mg/L). An abdominal computed tomography (CT) scan was performed, and 7-cm heterogeneous mesenteric mass lesion was found at right upper quadrant. The patient underwent laparoscopic exploration. During operation, was found pedunculated tumor at the mesentery of proximal jejunum, 7 cm × 7 cm × 4 cm in size, with torsion of the pedicle and local inflammatory reaction. The lesion was excised without the need for bowel resection. The postoperative course was uneventful. The patient was discharged 2nd postoperative day. On histopathological examination neoplasia was diagnosed as IMT.
Conclusions:
Mesenteric IMT can become symptomatic and present as an acute condition. We present the rare diagnosis of IMT, which may present as a mimic of other pathologies resulting in acute abdominal pain. Identification and recognition can assist clinicians to plan for its resection and the operative approach required to achieve this. Exploratory laparoscopy is a preferred method to confirm diagnosis. In some cases laparoscopic approach also may be safe and effective treatment modality.
Inflammatory myofibroblastic tumors (IMTs), also known as inflammatory pseudotumors are rare type of mesenchymal tumors with malignant potential, the most frequently involved sites are mesentery and omentum. Mesenteric IMTs are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgery. A review of the literature shows that only a relatively small number of mesenteric IMTs complications have been reported.
Case presentation
A 29-year-old female was hospitalized due to fever, localized muscle tenderness and right upper quadrant abdominal pain. The patient mentioned that she has suffered from symptoms for 2 days and had one the same episode in the past. Laboratory studies showed elevated white blood cells count (WBC – 13,2*109/L) and c- reactive protein level (CRP – 120 mg/L). An abdominal computed tomography (CT) scan was performed, and 7-cm heterogeneous mesenteric mass lesion was found at right upper quadrant. The patient underwent laparoscopic exploration. During operation, was found pedunculated tumor at the mesentery of proximal jejunum, 7 cm × 7 cm × 4 cm in size, with torsion of the pedicle and local inflammatory reaction. The lesion was excised without the need for bowel resection. The postoperative course was uneventful. The patient was discharged 2nd postoperative day. On histopathological examination neoplasia was diagnosed as IMT.
Conclusions:
Mesenteric IMT can become symptomatic and present as an acute condition. We present the rare diagnosis of IMT, which may present as a mimic of other pathologies resulting in acute abdominal pain. Identification and recognition can assist clinicians to plan for its resection and the operative approach required to achieve this. Exploratory laparoscopy is a preferred method to confirm diagnosis. In some cases laparoscopic approach also may be safe and effective treatment modality.
Backgroung
Inflammatory myofibroblastic tumors (IMTs), also known as inflammatory pseudotumors are rare type of mesenchymal tumors with malignant potential, the most frequently involved sites are mesentery and omentum. Mesenteric IMTs are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgery. A review of the literature shows that only a relatively small number of mesenteric IMTs complications have been reported.
Case presentation
A 29-year-old female was hospitalized due to fever, localized muscle tenderness and right upper quadrant abdominal pain. The patient mentioned that she has suffered from symptoms for 2 days and had one the same episode in the past. Laboratory studies showed elevated white blood cells count (WBC – 13,2*109/L) and c- reactive protein level (CRP – 120 mg/L). An abdominal computed tomography (CT) scan was performed, and 7-cm heterogeneous mesenteric mass lesion was found at right upper quadrant. The patient underwent laparoscopic exploration. During operation, was found pedunculated tumor at the mesentery of proximal jejunum, 7 cm × 7 cm × 4 cm in size, with torsion of the pedicle and local inflammatory reaction. The lesion was excised without the need for bowel resection. The postoperative course was uneventful. The patient was discharged 2nd postoperative day. On histopathological examination neoplasia was diagnosed as IMT.
Conclusions:
Mesenteric IMT can become symptomatic and present as an acute condition. We present the rare diagnosis of IMT, which may present as a mimic of other pathologies resulting in acute abdominal pain. Identification and recognition can assist clinicians to plan for its resection and the operative approach required to achieve this. Exploratory laparoscopy is a preferred method to confirm diagnosis. In some cases laparoscopic approach also may be safe and effective treatment modality.
Inflammatory myofibroblastic tumors (IMTs), also known as inflammatory pseudotumors are rare type of mesenchymal tumors with malignant potential, the most frequently involved sites are mesentery and omentum. Mesenteric IMTs are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgery. A review of the literature shows that only a relatively small number of mesenteric IMTs complications have been reported.
Case presentation
A 29-year-old female was hospitalized due to fever, localized muscle tenderness and right upper quadrant abdominal pain. The patient mentioned that she has suffered from symptoms for 2 days and had one the same episode in the past. Laboratory studies showed elevated white blood cells count (WBC – 13,2*109/L) and c- reactive protein level (CRP – 120 mg/L). An abdominal computed tomography (CT) scan was performed, and 7-cm heterogeneous mesenteric mass lesion was found at right upper quadrant. The patient underwent laparoscopic exploration. During operation, was found pedunculated tumor at the mesentery of proximal jejunum, 7 cm × 7 cm × 4 cm in size, with torsion of the pedicle and local inflammatory reaction. The lesion was excised without the need for bowel resection. The postoperative course was uneventful. The patient was discharged 2nd postoperative day. On histopathological examination neoplasia was diagnosed as IMT.
Conclusions:
Mesenteric IMT can become symptomatic and present as an acute condition. We present the rare diagnosis of IMT, which may present as a mimic of other pathologies resulting in acute abdominal pain. Identification and recognition can assist clinicians to plan for its resection and the operative approach required to achieve this. Exploratory laparoscopy is a preferred method to confirm diagnosis. In some cases laparoscopic approach also may be safe and effective treatment modality.
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