Colonic Lipoma With Intussusception

Abstract

A 51-year-old woman was admitted to the hospital with a 20-day history of intermittent abdominal cramping. Her stools had decreased in volume and had become watery. Physical examination revealed no fever or palpable mass. Computed tomography in the axial plane showed an intussusception of the transverse colon due to a primary mass with dominant fatty density. The relationship of the intussusception to the mass was well delineated on oblique multiplanar reformation, and a diagnosis of colonic lipoma was considered. The patient's obstructive symptoms resolved spontaneously, and she was hesitant about undergoing surgery. However, recurrence of her symptoms a few days later prompted exploratory laparotomy, which revealed a long-stalked mass approximately 7 × 6 × 5 cm at the transverse colon near the hepatic flexure. Resection of the tumor revealed multiple yellowish lobules. Pathologic examination disclosed a lipoma with no evidence of malignancy. Colonic lipomas are relatively rare and frequently asymptomatic. Most gastrointestinal lipomas arise in the submucosa. The colon is commonly affected, followed by the small intestine and then the stomach. Large lipomas may be associated with complications such as intussusception or intestinal bleeding.1Kabaalioglu A Gelen T Aktan S Kesici A Bircan O Luleci E Acute colonic obstruction caused by intussusception and extrusion of a sigmoid lipoma through the anus after barium enema.Abdom Imaging. 1997; 22: 389-391Crossref PubMed Scopus (12) Google Scholar Colonoscopic biopsy is usually performed to confirm the nature of the tumor. However, inadequate tissue samples often indicate nonspecific colitis because of adjacent mucosal inflammation produced by the lipoma.2Zhang H Cong JC Chen CS Qiao L Liu EQ Submucous colon lipoma: a case report and review of the literature.World J Gastroenterol. 2005; 11: 3167-3169Crossref PubMed Scopus (52) Google Scholar Computed tomography clearly reveals the characteristic fatty densitometric features of lipomas.3Liessi G Pavanello M Cesari S Dell'Antonio C Avventi P Large lipomas of the colon: CT and MR findings in three symptomatic cases.Abdom Imaging. 1996; 21: 150-152Crossref PubMed Scopus (41) Google Scholar Most lipomas demonstrate homogeneous fatty density with a thin fibrous septa, depending on the tumor size. If prominent fibrous septa and nodularity are evident, the most imperative differential diagnosis is a well-differentiated liposarcoma, despite the few reports of gastrointestinal liposarcomas in the literature.4Pereira JM Sirlin CB Pinto PS Casola G CT and MR imaging of extrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis, differential diagnosis, and pitfalls.Radiographics. 2005; 25: 69-85Crossref PubMed Scopus (137) Google Scholar