Gigantic large bowel lipoma of hepatic flexure

Abstract

Introduction: Lipoma is the third most common benign colonic neoplasm following hyperplastic and adenomatous polyps with a reported incidence of 0.2-4.4%. In 90% of cases, submucosa of the right colon is involved. These neoplasms are usually asymptomatic and require no treatment. However, giant lipomas, more than 4 cm in diameter are symptomatic in 75% of cases, causing intestinal obstruction and intussusception. Case report: 48-year-old man, with no significant medical history, nonsmoker, with unremarkable family history was admitted to hospital. Three weeks prior to admission, the patient experienced intermittent epigastric pain that lasted for 3 hours (8-9/10 on a pain scale). He also reported heartburn and flatulence following meals, as well as having change in appearance and stool frequency. Patient reported liquid stools with no traces of blood. Upper GI endoscopy showed no abnormalities. Colonoscopy revealed submucosal tumor at the level of hepatic flexure, 5.5 x3.5 cm in diameter with no other pathological finding. Abdominal MDCT reveals colonic wall thickening at the level of hepatic flexure 4.5 cm in diameter, interposition of transversal colon prehepatically and high below the diaphragm (Chialiditi syndrome). CEA values were within normal range. We performed laparscopical exploration followed by colotomy with tumor excision, through minimal upper midline incision. Histological finding confirmed the diagnosis of lipoma. Postoperative recovery was complicated due to pseudomembranous clostridial colitis but treated successfully with antibiotics. The patient is doing well, has no complaints 6 months after surgery. Conclusion: Reported incidence of colonic lipoma is rather low. However, giant ones are associated with high risk of intestinal obstruction, so we believe that detailed diagnostic work-up followed by elective operative treatment should be considered.