A Colonic Lipoma Causing Obstruction: A Case Report and Review of Literature

Colonic lipomas are rare benign lesions of the gastrointestinal tract. They are asymptomatic in the majority of cases. This report aims to present a case involving a 65-year-old female patient reporting rectal bleeding, loss of appetite, and alteration in bowel habits. First, she was submitted to colonoscopy which revealed a sizable ulcerative polypoid lesion in the descending colon, displaying histological characteristics consistent with a hyperplastic polyp and devoid of malignancy indications. An abdominal computed tomography followed which showed diffuse thickening of the colonic wall in the descending colon, resulting in nearly complete luminal obstruction and also a submucosal lipoma measuring 2.6 centimeters at the same location. Laparoscopic intervention ensued, and following a conclusive intraoperative diagnosis of a submucosal lipoma via frozen biopsy, a successful laparoscopic segmental resection of the descending colon with primary anastomosis was executed. Additionally, a comprehensive review of contemporary literature is provided to enhance the understanding of the management approaches applied in analogous cases since established treatment guidelines for colonic lipomas are currently lacking.

Colonic Lipoma: A Rare Cause of Intussusception

The most common and challenging chief complaint in the emergency department is abdominal pain. Intussusception, although rare in adults, is an important etiology to consider. The diagnosis is often delayed because of the nonspecific symptoms, especially in adults. This case highlights a rare case of intussusception in a middle-aged male with a colonic lipoma as a leading point. Endo-loop was applied to the colonic lipoma, leading to the resolution of intussusception. Therefore, this can be an effective alternative to surgery in select cases.

Laparoscopic limited hemicolectomy for descending colo-colic intussusception in an adult

Intussusception in adults represents 1% of bowel obstructions and up to 0.02% of all hospital admissions. Amongst these, colo-colic intussusception of the descending colon forms the rarest of causes due to the fixed nature of the descending colon. Most of adult intussusceptions follow a lead point and are commonly due to colonic malignancy which may get missed on pre-operative evaluation. Surgery is usually warranted as these patients are usually symptomatic and at risk of vascular compromise, leading to perforations and obscure malignancies. We present a case of laparoscopic limited hemicolectomy and primary anastomosis in a middle-aged male who presented with colo-colic intussusception, which appeared to be following a malignant mass on imaging and lipoma on colonoscopic biopsy done twice. Keeping in mind the possibility of a malignant lead point, no attempt was made to reduce the intussusception and a vessel first approach with 5 cm margin on either side was performed.

Giant Colonic Lipoma Remains a Surgeon's Domain: A Report of Two Cases

Colonic lipomas are rare benign submucosal tumors that are mostly asymptomatic. With increasing size, they may develop symptoms and complications. The acute presentation may be intestinal obstruction secondary to intussusception or gastrointestinal bleeding. The chronic presentation may be subtle and mimic a colonic malignancy. Symptoms include altered bowel habits, abdominal pain, lower gastrointestinal bleeding, and weight loss. Diagnostic evaluation includes advanced imaging such as Computed Tomography, Magnetic Resonance Imaging, and Endoscopy. With the advent of endoscopic submucosal dissection techniques, the therapeutic capabilities of endoscopy have expanded over the decade. However, surgical interventions were reserved for large, symptomatic lipomas, and resection varies from segmental colonic resection to hemicolectomy. Size and clinical presentation determine the therapeutic approach. We, with this, report two cases of giant colonic lipoma in the right colon causing a colo-colic intussusception.

Aurora rings may not always indicate an inverted colonic diverticulum: Report of a rare case of colonic lipoma

Aurora rings are prominent endoscopic features of the inverted colonic diverticulum (ICD), and their appearance alongside a colonic lipoma is an unprecedented phenomenon. The present study reports a case of colonic lipoma with Aurora rings, contradicting the assumption that Aurora rings are indicative of ICD. A 52-year-old male patient presented with left-sided abdominal pain for >1 year, associated with constipation in the form of the decreased frequency of bowel motions every 4 to 5 days. A physical examination revealed an obese, protuberant abdomen and a mildly tender left iliac fossa region without other notable findings. A transabdominal ultrasonography revealed a thickening of the large bowel wall (<7 mm) with a suspected inflammatory lesion on the left side of the colon. During an ileocolonoscopy, multiple diffuse diverticula of various sizes were observed, affecting the entire colonic mucosa. Furthermore, a large (1.5 cm) pedunculated polyp with a thick stalk was found in the sigmoid colon, exhibiting positive Aurora rings. A polypectomy was conducted with the deployment of two hemoclips at the polyp base to prevent perforation. The histopathological examination of the specimen, a 1.3 cm polyp, revealed the presence of a colonic lipoma, rather than an ICD. The identification of Aurora rings has emerged as a significant endoscopic feature in the diagnosis of ICD; nevertheless, the underlying etiology of these rings remains elusive. Based on an extensive search of the literature, no study was found mentioning the appearance of Aurora rings in an endoscopic screening of other colonic conditions other than ICD. The appearance of Aurora rings alongside a colonic lipoma has not previously been mentioned, at least to the best of our knowledge, which renders the differentiation of ICD from lipomas and polyps more challenging.

Clinicopathological features and management of colonic lipomas: Case reports

INTRODUCTION

Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management.

PATIENT CONCERNS

In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia.

DIAGNOSIS

Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis.

INTERVENTIONS

Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma.

OUTCOMES

Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up.

CONCLUSION

Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful.

Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review

Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Results: Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm³. Conclusions: A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization.

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.

Laparoscopic Resection of an Acute Rectosigmoid Intussusception Due to a Giant Pedunculated Lipoma

Intussusception is the invagination and telescopic migration of a proximal segment of the gastrointestinal tract distally and is classically described in the paediatric age group, accounting for 95% of reported cases. Intussusception in adults is highly uncommon; its aetiology involves a wide spectrum of pathologies, namely, concerning malignancy and differing management pathways. In the management of adult intussusception, consideration must be given to the potential malignant nature of the lesion, as reducing a malignant segment could render dissemination. Intussusception with non-malignant lesions like lipomas has been described, usually involving the right and transverse colons. In this case report, we review a rare case of adult colorectal intussusception secondary to a submucosal sigmoid lipoma.

Pedunculated sigmoid lipoma causing colo-colonic intussusception

This case report describes a 52-year-old man who presented with 2 weeks of left lower quadrant pain and bloody stool. Computed tomography revealed a 4 cm, fat-density mass acting as a lead point for intussusception of the sigmoid colon. Surgical resection was successfully performed, and histologic evaluation confirmed the diagnosis of a pedunculated colonic lipoma. Intussusception of the colon is uncommon in adults and is often associated with malignancy, but other nonmalignant causes such as a lipoma may also present similarly with obstructive symptoms, bloody stool, and/or intermittent abdominal pain. Colonic lipoma should be considered in the differential of a patient with clinical or imaging evidence of intussusception, with primary resection leading to an excellent prognosis.

Endoscopic resection of a giant colonic lipoma with endoloop-assisted unroofing technique: A case report

RATIONALE

Colonic lipomas are uncommon benign submucosal adipose tumorsthat are usually asymptomatic. Large lipomas can cause symptoms require treatment in principle. We report 1 case of giant colonic lipoma removed with endoloop-assisted unroofing technique instead of conventional surgical bowel resection.

PATIENT CONCERNS

A 62-year-old female patient presented with intermittent abdominal discomfort for 1 month.

DIAGNOSIS

The patient was diagnosed as having a giant colonic lipoma.

INTERVENTION

Endoscopic resection with endoloop-assisted unroofing technique was performed. On the 22nd day after resection, intestinal obstruction occurred by shedding mass was found; the symptoms of this patient disappeared soon after removal of the mass by endoscopy.

OUTCOMES

A follow-up colonoscopy 6 months later showed a scarred mucosa at the ligation site and no residual lipoma was observed.

LESSONS

Endoscopic resection with endoloop-assisted unroofing technique remains a viable option for giant lipomas; however, postoperative intestinal obstruction caused by shedding mass should be noted.

Giant colonic lipoma with prolapse through the rectum treated by external local excision: A case report

Colonic lipomas are a rare type of gastrointestinal benign tumor. Those that are <2 cm are generally asymptomatic and do not require any treatment. However, those that are >2 cm may be symptomatic, resulting in abdominal pain, changes in bowel habits, intestinal obstruction and rectal bleeding. A 39-year-old male patient presented with a mass prolapse through the anal canal, which was causing anal pain and rectal bleeding. The patient was admitted to hospital via the emergency services and directed to the Department of General Surgery with the preliminary diagnosis of a rectal prolapse. A pedunculated polyp (size, 10×8×7.5 cm) was detected at the 35th cm of the anal canal. Due to the large size of the polyp, an endoscopic polypectomy could not be performed. Therefore, the prolapsed lipoma was excised externally and the patient was discharged on the first postoperative day on which no complications were experienced. A colonic lipoma must be considered during the differential diagnosis of anorectal diseases, such as hemorrhoids and rectal prolapses. Local excision, hemicolectomy, and segmental and external resection should be considered in addition to an endoscopic polypectomy for the diagnosis and treatment of colonic lipomas.

Laparoscopic resection of colonic lipomas: When and why?

PATIENT

Male, >60 FINAL DIAGNOSIS: Colonic lipoma Symptoms: Rectal bleeding • abdominal pain • fatique • abdominal distention

MEDICATION

- Clinical Procedure: Laparoscopic resection Specialty: General surgery.

OBJECTIVE

We aimed to review and discuss the clinical picture and management of 4 patients who underwent laparoscopic colonic resection with a definitive pathology of colonic lipoma.

BACKGROUND

Colonic lipomas are rare benign nonepithelial tumors of the colon. They begin to be symptomatic when they reach a certain size, although the presentation can vary. Different endoscopic and surgical treatment strategies have been reported in the literature.

CASE REPORTS

Four male patients who underwent laparoscopic colonic resection and had definitive diagnosis of colonic lipoma were included in this report. All patients were over 60 years old. The first case presented with massive rectal bleeding. Obstructive symptoms and intermittent bleeding were prominent in the second and third cases. Abdominal pain and discomfort was present in the forth case. In the first 2 cases, abdominal CTs were suggestive of colonic lipoma and laparoscopic ileocecal resection was performed. However, malignancy could not be ruled out in the other 2 cases due to large size and heterogeneous appearance of the lesions and inconclusive endoscopic biopsies consisted of ulcer with exudate and inflammatory cells. Laparoscopic left and right hemicolectomy was performed in the third and forth cases, respectively. There were no complications in any patients.

CONCLUSIONS

Laparoscopic resection can be the first choice in treatment of colonic lipomas with various presentations. Wider resections should be considered in cases with uncertain diagnosis.

Large benign submucosal lipoma presented with descending colonic intussusception in an adult

Patient: Female, 34

Final Diagnosis: Lipoma of the large intestine

Symptoms: Abdominal pain • bloating • blood in stool • constipation • lose of appetite • nausea

Medication: —

Clinical Procedure: —

Specialty: Surgery