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Other unusual manifestations of lipomas include a case
report (Verwilghen et al. 2013) that describes a very large (41 kg) mesenteric lipoma as a cause of recurrent colic in one horse. The author speculated the broad and short mesenteric base found in the massive lipoma was less likely to create strangulation as typically seen with pedunculated lipomas. However, due to the weight and size of the mass, partial occlusion of the adjacent intestine by compression or tension, was hypothesised to be the cause of recurrent colic. Other forms of adipocyte accumulation causing colic, such as lipomatosis (Archer 2007) have also been described. Lipomatosis, in contrast to lipoma, is a nonencapsulated benign form of fat accumulation that is not limited by tissue planes (Archer 2007). Histologically it appears benign but can cause massive tissue infiltration. Two cases of lipomatosis have been reported to cause recurrent colic in horses (Henry and Yamini 1995; Riley et al. 2007). One report (Riley et al. 2007) described a case of colonic lipomatosis that resulted in simple nonstrangulating obstruction of the small colon and a previous report (Henry and Yamini 1995) was the first to describe infiltrative lipomatosis which led to the development of colic in a horse due to compromise of the muscular and neural structures of the colonic wall. An additional case of atypical diffuse infiltrative lipomatosis of the mesojejunum was reported in a mare that had experienced episodes of recurrent colic (Linnenkohl et al. 2013). In conclusion, intestinal strangulation by a mesenteric
Fig 2: A large (10 3 4 3 6 cm) pedunculated yellow, fluid-filled mass arising from the mesentery with a twisted black stalk located 385 cm from the pylorus on the mesentery of the jejunum. The mass ruptured upon manipulation and contained yellow clear fluid and a yellow/black soft tissue core of 2.5 3 6.5 cm when cut (necrotic, cavitated, fluid-filled lipoma). Photo courtesy of Dr. Katherine Watson.
unaffected. All three cases that underwent surgery had a good outcome without the necessity of requiring a resection and anastomosis of the associated intestinal segment, which would indicate that although there was variable venous occlusion, the mesenteric arterial supply was patent to maintain perfusion and intestinal viability. The authors speculated that the small intestine supplied by the affected mesentery could also have had sufficient collateral circulation from adjacent vessels. Although an exact manner by which the lipoma had injured the mesentery could not be determined, sufficient damage to the affected mesentery and mesenteric vessels resulted in venous occlusion and/or congestion similar to that seen with mesenteric haematomas (Van Hoogmoed and Snyder 1996). Van Hoogmoed and Snyder (1996) described acute small intestinal injury associated with haematomas in the mesentery of four horses. In two of these horses, haematomas in the mesentery were secondary to tears that disrupted the integrity of the mesenteric vessels; the result of a pedunculated lipoma in one horse and as a complication of parturition in the other horse. In the other two horses, the predisposing cause of the mesenteric haematomas causing ischaemic necrosis of the small intestine could not be identified. All horses in this case series had evidence of intestinal ischaemia associated with the mesenteric haematomas necessitating resection.
lipoma remains the most common cause of colic due to fatty accumulations in the abdomen, particularly in older horses. However, readers should be aware that other manifestations, such as mesenteric strangulation, as described in the current case report, chronic colic due to larger lipomas or lipomatosis can also be implicated and should be considered as potential causes of colic.
Authors’ declaration of interests No conflicts of interest have been declared.
Ethical animal research Not applicable for this clinical commentary.
Authorship
I. Kilcoyne wrote the commentary and J. Nieto edited the commentary.
References Archer, D.C. (2007) Lipomatosis: just another fatty lump?. Equine Vet. Educ. 19, 489-490.
Bauck, A.G., Graham, S.A., Smith, A., Rapp, H.J. and Freeman, D.E. (2020) Mesenteric strangulation by pedunculated lipomas without involvement of associated intestine in four horses. Equine Vet. Educ. 32, 411.
Blikslager, A.T., Bowman, K.F., Haven, M.L., Tate, L.P. and Bristol, D.G. (1992) Pedunculated lipomas as a cause of intestinal obstruction in horses: 17 cases (1983-1990). J. Am. Vet. Med. Assoc. 201, 1249- 1252.
Dart, A.J., Snyder, J.R., Pascoe, J.R., Farver, T.B. and Galuppo, L.D. (1992) Abnormal conditions of the equine descending (small) colon: 102 cases (1979-1989). J. Am. Vet. Med. Assoc. 200, 971- 978.
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