A case of giant colonic lipoma removed endoscopically using a modified hybrid technique

Colonic lipomas are benign adipose tumors and are mostly asymptomatic. They may cause symptoms when their size becomes more than 2 cm. Giant colonic lipoma (GCL) is a rare finding in endoscopy which presents with or without macroscopic ulceration and may lead to iron deficiency anaemia (IDA). The choice of treatment of symptomatic large colonic lipomas has been controversial. Here we are presenting a case of GCL presenting with occult bleeding causing iron deficiency anaemia (IDA). It was removed endoscopically using a combination of noradrenaline, endoloop ligation, and snare cautery technique (modified hybrid technique). Successful removal of the GCL lead to the resolution of IDA. This case report highlights that even GCL can be removed endoscopically, thus surgery can be prevented. Clinical Significance: GCL is an unusual cause of anemia. Modified hybrid endoscopic removal technique improves safety.

Large colonic lipoma with a laterally spreading tumor treated by endoscopic submucosal dissection: A case report

BACKGROUND

Since fat does not transmit electrical energy well, delayed perforation and post-polypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma. The endoscopic submucosal dissection (ESD) technique concentrates electrical energy conducts to the submucosa, not the adipose tissue. This helps to minimize electrical thermal injury, especially in the case of large colonic lipomas. In rare cases, such as colonic lipomas accompanied by mucosal lesions, it is difficult for endoscopists to decide how to safely remove them.

CASE SUMMARY

A 78-year-old man underwent colonoscopy for colorectal cancer screening. During colonoscopy, a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm. A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma. The lipoma was so large that it occupied much of the inside of the colon, making it difficult to see the entire laterally spreading tumor (LST) at once. The LST was confined to the surface of the lipoma, which had a semipedunculated shape with a wide neck. The margin of the LST was not observed at the neck of the lipoma. ESD was performed and the colonic lipoma with the LST was successfully removed without complications. After 3 d of hospitalization, the patient was discharged without any symptoms. The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with low-grade dysplasia.

CONCLUSION

ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.

Colonic lipomas revisited on CT colonography

PURPOSE

CT colonography (CTC) is growing in its utilization as a nationally approved colorectal cancer screening test. After colonic polyps, lipomas are the second most common colonic lesions and their accurate and rapid recognition are important.

METHODS

This retrospective Institutional Review Board approved study was performed at two large academic university-based institutions. 1044 patients underwent CTC at Institution A from 2010 to 2018 and 1094 patients underwent CTC at Institution B from 2003 to 2015. All CTC examinations with at least one colonic lipoma in their report were evaluated by a fellowship-trained abdominal imaging radiologist. 47 CTC examinations containing 59 colonic lipomas were detected and included. Segmental location, sessile versus pedunculated morphology, multiplicity, average attenuation, and largest lesion diameter were evaluated. A review of the current literature on colonic lipomas is entailed.

RESULTS

The overall incidence of colonic lipoma was 2.2% in women and 2.3% in men. Mean age for detection of colonic lipomas on CTC was 66.9 years. Segmental locations of colonic lipomas include ascending colon (39%), transverse colon (19%), ileocecal valve (12%), cecum (12%), descending colon (10%), and rectosigmoid (8%). 9% of colonic lipomas were multiple, 42% were pedunculated, and 58% were sessile. The mean (range) size of detected lipomas was 19 (6-59) mm. The mean (range) attenuation was - 132 (- 41 to - 258) HU.

CONCLUSION

Most colonic lipomas are located in the ascending colon. Although they are typically solitary, just under 10% are multiple, and although they are most often sessile, slightly under half are pedunculated mimicking polyps. CTC detects smaller lipomas than optical colonoscopy.

Intussusception related to transverse colonic lipoma: a case report and review of the literature

Lipomas are rare and benign colonic soft tissue lesions derived from mature adipocytes. Their poor clinical expression usually leads to a coincidental discovery during procedures like colonoscopy, imagery, surgery or autopsy. Due to their small size, a simple observation would usually be recommended. However, colonic lipomas (CLs) with clinical symptoms or signs including abdominal pain, nausea, vomiting, diarrhea, anaemia or even intussusception would need invasive treatment. It is recommended to perform surgery to treat CLs that are >2 cm. Endoscopic procedures could be an interesting alternative for the future but would still require further investigation. We report the case of a 30-year-old patient with transverse CLs leading to obstruction of the descending colon by intussusception and continue by presenting a review of the current literature.

An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

INTRODUCTION

Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required.

CASE REPORT

A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic.

DISCUSSION/CONCLUSION

Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.

A Cecal Lipoma Causing Intussusception, Detected on Routine Outpatient Abdominal Ultrasound

This case reports on a patient presenting with abdominal pain of 1-month duration; in whom, ultrasound (US) detected a colonic lipoma with intussusception. Further investigation with computed tomography confirmed this finding, and successful endoscopic removal of the lipoma was performed. This case highlights the importance of careful evaluation of the region of interest during US, knowing the appearance of lipoma on US and other modalities, thus aiding its adequate management.

Curative endoscopic treatment of intussusception due to a giant colonic lipoma using a wedged balloon and ligation with detachable snares

A 67-year-old woman presented with symptoms of bowel obstruction. Radiographic and ultrasonographic findings suggested colo-colonic intussusception caused by a colonic lipoma. Colonoscopy with an endoscope tip balloon was performed for reduction. The intussusception was partially reduced by injecting dilute contrast media with a wedged inflated balloon at the endoscope tip. For definitive treatment of the polyp, ischemia was induced using a detachable snare. The abdominal pain well improved after endoscopic treatment. However, ultrasonography suggested a residual lesion. Another detachable snare was applied to the stalk on day 6. A large amount of dark-red necrotic tissue was passed per anus the following day. One month later, complete scarring of the site was confirmed colonoscopically. This is the first report of curative endoscopic treatment of an intussusception due to a giant colonic lipoma with detachable snares after the reduction with a wedged balloon of colonoscope tip.

Partial spontaneous anal expulsion of the right colon lipoma: An exceptional diagnostic circumstance

Introduction

Lipomas are most common benign tumors of the colon. They are asymptomatic and fortuitously discovered on a morphological examination. Rarely, they cause complications such as acute intussusception. In this article, we reported an exceptional discovery mode of right colon lipoma.

Case presentation

A 54-year-old woman has consulted for acute abdominal pain relieved by the anus emission of a fat ball that she brought back with her. Abdominal computed tomography scan showed the remaining part of a lipoma developed in her right colon. Laparoscopic right colonic resection was performed.

Discussion

Colic lipomas are usually asymptomatic and surgical indication in these cases is debated, but it is indicated whenever complications occur such as acute intestinal intussusception. In this case, discovery mode was not considered as a complication because lipoma evacuation could have been complete. Radiological explorations and colonoscopy could evaluate the lesional state. When surgery is decided, intersecting therapeutic strategy of a short colonic resection guided by a colonization during colonoscopy should be considered.

Conclusion

The spontaneous expulsion of a colonic lipoma is very rare. Our observation showed that this expulsion may be partial. +The changes that the lipoma undergoes can evoke a malignant cause. a supplement to take care of this eventuality is necessary.

Colonic intussusception in descending colon: An unusual presentation of colon lipoma

Lipomas of the colon are relatively rare benign soft tissue tumors derived from mature adipocytes of mesenchymatic origin. During colonoscopy, surgery or autopsy they are generally discovered incidentally. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, in the cases with larger in size of tumor some symptoms such as anemia, abdominal pain, constipation, diarrhea, bleeding, or intussusception may be presented. We reported a 47-year-old woman with colonic intussusception in the descending colon caused by colonic lipoma and diagnosed after surgical exploration for obstructive colonic mass.

A Rare Cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception

Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology.

Two Patients with Large Colonic Lipomas for which Endoscopic Unroofing was Ineffective

Endoscopic unroofing is effective for treating large colonic lipomas. However, additional endoscopic resection is occasionally required when the outcomes of initial unroofing are incomplete. The colonoscopy of an 82-year-old woman with abdominal pain revealed a yellowish lipoma of about 20 mm in the transverse colon. The mass was treated by unroofing, but a follow-up colonoscopy 5 days later revealed residual lipoma. One month later, the regenerated surface had become covered with mucosa, and the status of the lipoma had returned to that before unroofing. The colonoscopy of a 74-year-old man with abdominal pain and melena revealed a 50-mm-wide protruding lipoma in the transverse colon. The mucosa of the upper third of the lipoma was excised using an electric knife and snare, which allowed the immediate partial drainage of adipose tissue. Unroofing proceeded, but 7 days later, the unroofed surface had become coated with a white substance, and the residual lipoma required additional endoscopic resection. Colonic lipomas are often asymptomatic. However, patients with abdominal pain and hemorrhage should be treated in consideration of complete resection, but not by unroofing, which could leave a residual tumor. Drainage should be confirmed after unroofing and any residual lipoma should be treated by additional resection.

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.

Surgery for symptomatic colon lipoma: a systematic review of the literature

AIM

Isolated colon lipomas are rare benign tumors. We herein conducted a systematic review of the literature to identify clinical characteristic, diagnostic and treatment options.

MATERIALS AND METHODS

A search for relevant studies was conducted in Scopus, Embase and Medline databases until the end of May 2014. The search terms were "colonic lipoma and colon lipoma". Articles were included if they had information on symptoms, lipoma characteristics and type of procedure performed.

RESULTS

88 articles describing 184 patients affected with colonic lipomas were found. One hundred and twenty-seven patients were selected for further analysis. The most common signs included abdominal pain, rectal bleeding and alteration in bowel habits. Colonic lipomas were frequently localized in the right colon (50%). The majority of patients had open surgery, whereas current treatment is laparoscopic resection.

CONCLUSIONS

Laparoscopic surgery is the current standard-of-treatment of symptomatic colonic lipomas greater than 2 cm in diameter or when malignancy can not be preoperatively excluded.

Unroofing technique for endoscopic resection of a large colonic lipoma

A 77-year-old man presented with repeated episodes of melena. He had a medical history of hypertension, atrial fibrillation and cardiogenic brain infarction and took medications, i.e. an antiplatelet agent. Laboratory data revealed iron deficiency anemia. Colonoscopy revealed a yellowish smooth submucosal tumor, 50 mm in diameter, on the Bauhin valve. The lesion was soft and compressible. The overlying mucosa was erosive. CT scan showed a uniform mass with very low density in the ascending colon, corresponding to the above-detected lesion. The clinical diagnosis of colonic lipoma was established. Using a 25 mm electrocautery snare (Olympus, Tokyo, Japan), we transected the upper portion of the mass to unroof the lesion. The mucosa layer was thick and hard. Fat tissue was observed extruding from the cut surface, consistent with the diagnostic hypothesis. After dissecting the overlying mucosa on the anal side by means of an IT knife (Olympus) in order to completely extrude the mass, the fat tissue was further exposed. It took about 26 min to perform the whole procedure. There were no procedure-related complications. Macroscopically, the resected lesion was a yellow solid tumor, 1.6 × 1.5 × 0.7 cm in diameter. Histopathologic examination of the excised specimen confirmed the diagnosis of a lipoma. The clinical course was uneventful. A follow-up endoscopy 1 month later showed a scarred mucosa at the resection site. Similarly, a follow-up CT scan 2 months later revealed no evidence of residual lipoma. The unroofing technique is safe, easy and suitable for the treatment of large lipomas.

Autoamputation of a giant colonic lipoma

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously.

Colo-colonic intussusception caused by a submucosal lipoma: case report and review of the literature

Adult intussusception is a rare clinical presentation and often not considered clinically in the differential diagnosis of adult patients with vague abdominal complaints. A 44-year-old woman visited our emergency department with sudden onset of intermittent abdominal pain. Diagnostic imaging revealed an intussusception caused by a submucosal lipoma of the sigmoid. A laparotomy was performed and the diagnosis was proven by histological examination. Submucosal lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain and thus mimic a malignancy. Surgical excision is indicated for symptomatic cases.

Cecal lipoma with pseudomalignant features: A case report and review of the literature

Colonic lipoma is a well-documented benign neoplasia, endoscopically appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopically performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.