jl} : june · 2018. 10. 12. · giant mesenteric lipoma - a case report - su yun choi, m.d., hong...
TRANSCRIPT
47 ±o}5'1 Jl} : Al110 1'1 All 1:Q.. 2004\'! Vol. 10. No. 1. June 2004
Giant Mesenteric Lipoma
- a Case Report -
Su Yun Choi, M.D., Hong Kim, M.D., Jeong Hong, M.D.
Department of Surgery, Pediatric Surgery, Ajou University College of Medicine,
Suwon, Korea
Visceral lipoma originating from the mesentery is very rare in childhood. A 29-month-old male presented with painless abdominal distension. Abdominal ultrasonography and CT revealed a huge multilobulated hypodense mass in the peritoneal cavity. Exploratory lapa
rotomy showed a 26X25X5 cm sized encapsulated, lobulated, homogenous mass, which originated from the transverse mesocolon. Histologic examination revealed a lipoma. The postoperative course was uneventful. (J Kor Assoc Pediatr Surg 100):47-51), 2004.
Index Words: Giant lipoma. IV[esentery. 1\l[esoco!on
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Correspondence : Jeong Hong, MD., Department of Surgery,
Pediatric Surgery, Ajou University College of Medicine, San 5,
Won-Cheon-dong, Suwon, Kyunggi-do 442-729, Korea
Tel: 031) 219-5203, Fax: 031) 219-5755 E-mail: [email protected]
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1. Wolko JD, Rosenfeld OL, Lazar MJ, Underberg-Davis
S1.: Torsion of a giant mesenteric lipoma. Pediatr Radi-
01 33(1):34·36, 2003
2. 8ato M, Ishida H, Konno K, Komatsuda T, Naganuma
H, Scgawa 0, Watanabe S, Ishida J.: Mesenteric lipo
ma: report of a case l1Jith emphasis on [is findings.
Eur Radiol 12(4):793·795, 2002
3. K~U1ildides C, Frykberg T, Lundkvist K.: Paediatric me
senteric lipoma. an unusual cause of repeated abdo
minal pain. A case report. Acta Radiol 39(6):695-697,
1998
4. Ilhan H, Tokar B, Isiksoy S, Koku N, Pasaoglu 0.:
Giant mesenteric lipoma. Pediatr Surg 34(4):639-640,
1999
5. Barrientos femandez G, Luque f\.1ialdea R, Navascues
del Rio JA, Sanchez Martin R, Cerda BelTocal J, Martin
Crespo R, Vazquez Estevez 1: Primary mesenteric solid
tumors in childhood: a case of mesenteric lipoma app
roached by laparoscopy. An Esp Pediatr 50(2):175-176,
1999
6. Tahlan RN, Garg P, Bishnoi PK, SingJa SL.: lvfesenteric
lipoma: an unusual cause oj" small intestinal volvulus.
Indian J Gastrocntcrol 16(4):159, 1997
7. Fultz PI, Hampton \VR, Skucas I, Sickel IZ.: Dtffe
rential diagnosis of .((a-containing lesions with abdomi
nal and pelvic CT. Radiographics 13(6):1265-1280, 1993
8. Colovic R, Colovic N, Zogovic S.: j\1esenteric lipoma
causing volvulus qi the small intestine. Srp Arh Celok
Lek 128(5-6):205-207, 2000
9. ~i'l:§L ..:-t:°8~: Lipoma of the greater omentum . .2.1.:IIl"'I§I"I 14(9):715-718, 1972
10. Francois A, Bodenant C, Rives N, Bachy B, MitrofanolT
P, Mace B, Hemet I.: lvfesenteric lipoblastoma "vith
changes in chromosome 8: use of cytogenetics in the
diagnosis (?f adipocytic tumors in children. Ann Pathol
17(6):406-411, 1997
II. Daly 1M, Adams IT, Fantini GA, Fisher IE: Abdominal
lvall, omentum, mesentery, and retroperitoneum, in Sch
wartz SI, Tom Shires G, Spencer Fe, Daly .1M, Fisher
lE, Galloway AC(eds): Principles of Surgery(ed 7), NY,
Gl
McGraw-Hili, 1999, Pp1551-1584
12. ;<jA~:§l %rtl¥l, o1!"cJ',}, ~~J01: s:'0/-of!A72.! cllf{;l- 1z,L1f W ?f?fu/- 1z,1-%-. r11~h1::o}9-1i!l--q{§~Al 8(1): 77. 2002
13. Thomas Stocker I, Dehner Louis P: Pediatric Pathology,
(ed 2), Philadelphia, I B Lippincott Company, 1992,
P693-694
14. 0F~i:-, o1;<jit, ~lHl* : 1f?J r_Jl-of! Ij}-AJVJ- !4§!§t Yl i!f!/Ifl 'iff!- :'r?l "'I'if'it'. "I Ao}§1"I 45(1):129-132,
1993
15. Vasilescu C, Popa C, Ionescu M.: Primary solid tumors
of the mesentery. Chirurgia (Sueur). 44(4):55-64, 1995
16. 9}71"71, ~?}-:r-a- : '?F?lu/-Jl/- C/!~}-(ji! %A!of! WAJ?! 7.!~r
'it' J ofl. "IA"'r§I"1 21(4):81-84, 1979
17. Signer RD, Bregman D, Klausner S: Giant lipoma of
the mesentel)J report oj" an unusual case and review
of the literature. Am Surg 42:595-597, 1976