A Case of Jejunal Lipoma Involving a Free Jejunal Graft

Abstract

We report a case of jejunal lipoma identified while performing a free jejunal transfer for esophagopharyngeal reconstruction. A 74-year-old man was hospitalized with hypopharyngeal carcinoma. After pharyngo-esophagectomy, his cervical esophagus was reconstructed using a free jejunal graft. A submucosal tumor was identified while performing the free jejunal transfer. The 28 × 12 × 10mm tumor was oval, non-pedunculated, and yellowish and was covered by a thin membrane. Jejunal lipoma was diagnosed on the basis of its appearance. We excised a part of the free jejunal graft including the lipoma and reconstructed the cervical esophagus. The patient had a history of recurrent ileus. Jejunal lipoma has been reported as a possible cause of ileus. However, jejunal transfer is generally performed without preoperatively analyzing the jejunum. In the present case, the lipoma possibly caused some gastrointestinal obstruction after the reconstruction surgery. A few cases of jejunal neoplasm, including jejunal lipoma, have been reported. However, in cases of recurrent ileus, as observed in our patient, the use of diagnostic imaging (computed tomography, etc.) to examine the intestines before free jejunal transfer is important. Furthermore, medical practitioners should check for the presence of intestinal tumors during the reconstruction surgery.