Education and imaging. Gastrointestinal: lipoma induced intussusception of the transverse colon

Sizzling Fat-Curative Endoscopic Resection of a Giant Lipoma Causing Colo-Colic Intussusception

Giant colonic lipomas, tumors that infrequently occur in the gastrointestinal tract, can manifest as bleeding, abdominal pain and, in few cases, obstruction with intussusception. Surgery is usually the treatment of choice. We report the case of a 78 years-old woman with abdominal pain, constipation, and bleeding due to a giant lipoma of the sigmoid colon causing intussusception. After an initial diagnostic colonoscopy, the patient underwent an endoscopic mucosal resection (EMR) without complications. Even if surgery is traditionally the primary therapeutic approach for giant colonic lipomas, selected cases can be successfully treated with EMR.

Solitary lipoma of ileocaecal valve mimicking Crohn's disease: A case report of a challenging diagnosis for a rare benign tumor of the intestinal tract

INTRODUCTION AND IMPORTANCE

Symptomatic ileocaecal lipomas is a fascinating disease, it represents a distinctive subtype of bowel lipomas for two main reasons: it is so rare that its exact incidence is unknown, second its clinical and radiological features are so unspecific that it remains a challenging diagnosis. In terms of treatment surgical resection is indicated when doubting malignant origin, or in case of symptomatic lipomas. Through anatomopathological findings, diagnosis can be confirmed.

CASE PRESENTATION

We herein report a case of an obstructive lipoma of the ileocaecal valve mimicking Crohn's disease, presented as a case of small bowel obstruction evolving for days without clinical, biological, or radiological signs of severity. After overcoming the acute phase, a series of clinical and radiological findings were in favor of inflammatory origin whereas endoscopic investigations showed a fibrotic stenosed ileocaecal valve. The patient underwent ileocaecal resection with primary anastomosis. Anatomopathological reports confirmed the diagnosis of lipoma without any signs of malignancy. No complications were observed.

CLINICAL DISCUSSION

Symptomatic ileocaecal lipoma is a rare pathology, with unspecific signs in clinical examination and radiological features. Surgical management is not common practice. It is reserved for symptomatic tumors, or when in doubt of malignant origin.

CONCLUSION

Amongst benign tumors, ileocaecal lipomas are a rare entity. Due to its misleading symptoms, achieving a positive diagnosis can be challenging. The main problem of these tumors is their differential diagnosis with Crohn's disease, like our case, therefore leading to surgical resection to confirm or infirm malignancy.

Lipoma-Associated Intussusception of the Transverse Colon

Intestinal intussusception rarely occurs in adults and is challenging to diagnose in the emergency department due to its associated nonspecific symptom of abdominal pain. Most of these incidences are caused by a neoplasm within the bowel acting as a lead point. Lipomas are benign fatty tumors that rarely develop in the colon and are very infrequently a precursor lesion to intussusception. Our present report describes a case of lipoma-associated intussusception in the transverse colon in an adult who presented with complaints of abdominal pain and acutely worsened chronic constipation. Computerized tomography (CT) imaging and barium enema revealed colocolonic intussusception with a lipomatous lead point and complete obstruction. The patient was admitted for same-day intervention and underwent a successful colectomy with no complications.

Colonic Lipoma as a Leading Cause of Intussusception Resulting in Bowel Obstruction

A colon lipoma is defined as a benign tumor made of adipose tissue present in the submucosa. Lipomas of the colon are unusual with a frequency of 0.035%-4.4%. We present an uncommon case of a 41-year-old female with left colonic lipoma causing intussusception. The patient presented with abdominal pain at the left iliac fossa. She underwent an emergency exploratory laparotomy plus left hemicolectomy and was followed in the surgical out-patient clinic postoperatively. She was found doing well taking a normal diet and having normal bowel habits. The overall prognosis depends on the complete removal of the tumor.

Splenic flexure colonic lipoma causing intussusception

Colonic lipomas are rare benign tumours that are usually asymptomatic. However, giant colonic lipomas tend to be symptomatic and can occasionally result in intussusception and intermittent colonic obstruction. As adult intussusception is an uncommon occurrence, the identification of the underlying aetiology is essential due to its high association with malignancy. Computed Tomography remains the tool of choice for the diagnosis of colonic lipomas. Surgical excision remains the mainstay treatment of giant symptomatic colonic lipomas. We hereby present the case of a 51-year-old male found to have a colonic lipoma causing recurrent intussusception. We discuss the approach, diagnostic tools and available treatment modalities for colonic lipomas. We also provide a brief literature review of intussusception in adults.

Lipoma of the transverse colon covered by tubulovillous adenoma: a rare indication for surgical treatment

Lipomas of the digestive tract are rare benign tumours which, in most cases, are totally asymptomatic. Because of their localization within the intestinal wall, endoscopy may be completely negative so contrast-enhanced computed tomography (CT) is very important for detecting and typing these lesions. The case of a 49-year-old man with abdominal pain is presented. Colonoscopy and biopsy of a polypoid lesion on the right colonic flexure concluded for tubulovillous adenoma. The subsequent CT showed a polylobate lesion of 5 cm in diameter with predominant fat density causing luminal sub-stenosis. Histological examination of the surgical specimen confirmed the presence of a voluminous submucosal lipoma. CT allows to diagnose lipomas of the large bowel thanks to the density measurement (between -40 and -120 Hunsfield Units) with an accurate detection of the site and nature of lumen stenosis.

Large ileocecal submucosal lipoma presenting as hematochezia, a case report and review of literature

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Ileocecal lipomas present typically with intussusception.There are only few reported cases of ileocecal lipomas presenting as lower GI bleeding.

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Histopathological evaluation remains the gold standard in precise diagnosis.

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The treatment of colonic lipomas is debatable among specialists.

Introduction

Colonic lipomas are rare subepithelial benign tumors affecting mainly middle-aged women. They are usually asymptomatic and, hence, are discovered incidentally on autopsy, surgery, or colonoscopy. There is a wide range of presentations like abdominal pain, bleeding per rectum, intussusception, etc. The latter picture constitutes the usual presentation of an ileocecal lipoma. Only few cases of ileocecal lipomas presenting as lower GI bleeding have been reported in the literature.

Presentation of case

We present a case of an adult female patient who was admitted to our institution complaining of hematochezia and right lower quadrant pain. She was found to have chronic anemia. She was investigated by CT scan of the abdomen & pelvis and by colonoscopy which showed a fungating, submucosal mass with ulcerated base near the ileocecal valve. She underwent a colonic resection. The pathology came out as a submucosal benign pedunculated ileocecal lipoma.

Discussion

Colonic lipomas represent 4% of benign lesions of the gastrointestinal tract. They are usually asymptomatic hence are often discovered incidentally on colonoscopy, surgery or autopsy. The definitive diagnosis is made by pathological evaluation. Colonic lipomas are usually treated if they are symptomatic or there is any suspicion of malignancy. The treatment modalities include endoscopic and surgical resection.

Conclusion

We, hereby, describe a case of benign ileocecal lipoma that presented with hematochezia which is an unusual presentation. Also, there is a great controversy regarding the treatment of colonic lipomas. In this article, we tried to answer several questions concerning the management of ileocecal lipomas.

Colonic lipoma: an analysis of six cases

AIM: To summarize the clinical features of colonic lipoma and to analyze reasons for misdiagnosis of this disease.

METHODS: The clinical data for six patients with colonic lipoma who underwent treatment at our hospital from 1995 to 2010 were reviewed retrospectively to analyze the iconographic and clinicopathologic characteristics of the disease and the reasons for misdiagnosis.

RESULTS: Three patients initially diagnosed with colonic carcinoma at barium enema examination revealed a radiolucent spherical filling defect with well-defined margins. One patient was initially diagnosed with colonic polyposis by abdominal CT scanning. In all patients, colonoscopy revealed a lump located in the submucosa of the colon. Of six patients, one was diagnosed with colonic lipoma, three were misdiagnosed with colonic carcinoma, and two were misdiagnosed with colonic polyposis. Only one case was accurately diagnosed before hemicolectomy, and the misdiagnosis rate was 83.3%. The reasons for misdiagnosis included rarity, unspecific clinical manifestations, absence of typical endoscopic findings because of inflammation and erosion of tumor surface, and docter's insufficient knowledge of colonic lipoma.

CONCLUSION: Correct diagnosis of colonic lipoma can be achieved by multiple endoscopic biopsies. Endoscopic electroresection or local intestinal resection can be selected in patients with colonic lipoma.

Endoscopic resection of gastrointestinal lipomas with negative pressure using a transparent cap: an analysis of 16 cases

AIM: To evaluate the efficacy and safety of endoscopic resection of gastrointestinal lipomas with negative pressure using a transparent cap.

METHODS: The clinical data for 16 patients who were diagnosed with gastrointestinal lipoma by gastroscopy or colonoscopy and underwent endoscopic resection with negative pressure using a transparent cap from January 2008 to July 2011 were retrospectively analyzed. The clinical efficacy, safety and complications of this procedure were evaluated.

RESULTS: The procedure was successful in all the 16 cases. Oozing of blood was observed intraoperatively in two cases, and clips were used to close the wound. No complications such as perforation and massive hemorrhage occurred during the operation. During 1 to 36 months of follow-up, no recurrences were observed.

CONCLUSION: Endoscopic resection of gastrointestinal lipomas with negative pressure using a transparent cap is effective, safe and simple.

Colo-colonic intusussception secondary to a lipoma

We present a case of subacute obstruction in a 49 years old lady due to colo-colonic intussusception secondary to a lipoma. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.