Colonic Lipoma Research Articles

Laparoscopic resection of a sigmoid colon lipoma in a young female patient: A case report and review of the literature.

Lipomas of the sigmoid colon are rare entities. The present case describes a 27-year-old Caucasian woman who underwent a laparoscopic sigmoidectomy following the detection of a giant lipoma. The young patient was referred to the Emergency Department of the University Hospital of Heraklion (Crete, Greece) in May 2013 after experiencing intermittent abdominal cramping during defecation, and altering episodes of diarrhea and constipation. In addition, the patient described the protrusion of a solid tissue mass shaped like a 'champagne bottle cork' from the anus following defecation. These symptoms had been present for 1 month prior to referral. Physical examination was unremarkable. An urgent colonoscopy revealed a polypoid lesion measuring 2.5 cm in diameter in the sigmoid colon, which was located ~12 cm above the anal ring, with a smooth surface and tissue fragility. Tissue samples were obtained and sent for histopathological analysis. Preoperative contrast-enhanced computed tomography was performed urgently and confirmed the presence of a solid mass in the sigmoid colon without enlargement of regional lymph nodes. Following adequate preparation, the patient underwent a laparoscopic sigmoidectomy with intracorporeal termino-terminal colorectal anastomosis, with the use of a circular stapler. The patient had a positive post-operative outcome without complications and was discharged on day 4 post-surgery in an optimal condition. Histopathological examination of the surgical specimen demonstrated a pedunculated lipoma shaped like a 'champagne bottle cork'. The tumor consisted of mature adipose cells. The overlying colonic mucosa showed hyperplastic crypts with regenerative changes. In the lamina propria mild inflammatory infiltration was observed. At 2 years post-surgery, the patient remains asymptomatic without any clinical evidence of recurrence.

Colonic intussusception by a giant colon lipoma: A case report

IntroductionColonic lipomas are extremely rare, and they can mimic clinical manifestations of a colonic carcinoma, presenting with bowel obstruction or intussusception. We present a case of a 57-year-old female with a colonic lipoma causing a colonic intussusception. A review of the literature is also included. Presentation of caseA 57-year-old female patient arrived to the emergency department with bowel obstruction. Imaging studies revealed intussusception triggered by a colonic pediculate lipoma. A left colectomy was performed and the patient had an uneventful recovery. DiscussionTwo-thirds of colonic intussusceptions are associated with malingnant tumors. There are several therapeutic interventions for the treatment of this disease, which include a segmental colectomy, local excision and even endoscopic removal. Colonic lipomas are extremely rare, and they can mimic a malignant tumor, so it is imperative for the surgeon to rule out a malignancy in order to opt for a more conservative or minimal approach. ConclusionIf the diagnosis of a benign disease is uncertain in patients presenting with colonic intussusception, then it should be managed as a malignant lesion due to the higher incidence of large bowel adenocarcinomas presenting with this disease.

Giant Colorectal Lipoma of Left Colon: Case Report and Literature Review

Giant Colorectal Lipoma of Left Colon: Case Report and Literature Review

Colo-Colic Invagination on Lipoma

Intussusception in adults is rare and accounts for 1% to 5% of cases of acute bowel obstruction. Moreso, colic intussusception remains exceptional in adults and is usually secondary to an endoluminal lesion. Abdominal intestinal lipomas are rarely responsible for colonic invagination. They are often located on the caecum or the ascending colon and rarely on the left colon. We report the case of colo-colic invagination on a descending colon lipoma in a 50-year-old woman.

Trimming the Fat

FigureThis is a case presentation of a 62 year old woman who initially presented for a screening colonoscopy. She was incidentally found to have a large 7 cm lipoma in the transverse colon. One week later, she presented to the emergency room with intermittent lower abdominal pain. She underwent a CT scan which revealed an intussusception caused by the large colonic lipoma. Surgical and endoscopic interventions were offered to the patient and the decision was made to pursue an endoscopic approach. Using a hybrid EMR-ESD technique described in detail in the video, the large colonic lipoma was successfully removed.

Colonic lipoma: A rare yet important cause of intestinal obstruction

Gastrointestinal tract (GIT) lipomas are rare, benign mesenchymal neoplasm affecting all segments of the GIT and colon is affected most frequently. Reported incidence of colonic lipomas varies from 0.2% to 4.4%. These tumors are believed to arise from the connective tissue of the wall of the intestine. We here describe a case of 60-year-old male who presented with features of intestinal obstruction. The patient underwent left hemicolectomy for a mass involving proximal descending colon. Diagnosis of colonic lipoma was made on histopathological examination.

内視鏡的切除により診断が得られた脂肪腫の1例

Progressive anemia was found in a 73-year-old man with an old myocardial infarction who was seeing a cardiovascular internist regularly. Because a fecal occult blood test showed a positive result, we performed a colonoscopy and observed a pedunculated tumor mass with a diameter of 40 mm in the presence of blood clots on the surface of its tumor mass. We judged that this tumor mass was the cause of the bleeding and therefore performed endoscopic excision. The tumor mass was histopathologically diagnosed as a lipoma. A colonic lipoma is a benign non-epithelial tumor, with a frequency around 3% of autopsy cases ; it is relatively rare in clinical practice.

Intestinal Obstruction Caused by Ileocolic and Colocolic Intussusception in an Adult Patient with Cecal Lipoma.

Introduction. Intussusception is a rare clinical entity in adults (<1% of intestinal obstructions). Colonic intussusception is even rarer, particularly when caused by lipomas. Case Presentation. A 47-year-old woman presented to our emergency department complaining of abdominal pain with vomiting and diarrhoea. X-ray and CT showed bowel obstruction due to ileocolonic and colocolonic intussusception; a giant colonic lipoma (9 × 4 × 4 cm) was recognizable immediately distally to the splenic flexure of the colon. The patient underwent emergency laparotomy and right hemicolectomy. Assessment of the resected specimen confirmed the diagnosis of giant colonic polypoid lesion near to the ileocecal valve, causing a 12 cm long intussusception with moderate ischemic damage. Conclusion. Colonic obstruction due to intussusception caused by lipomas is a very rare condition that needs urgent treatment. CT is the radiologic modality of choice for diagnosis (sensitivity 80%, specificity near 100%); since the majority of colonic intussusceptions are caused by primary adenocarcinoma, if the etiology is uncertain, the lesion must be interpreted as malignant and extensive resection is recommended. At present, surgery is the treatment of choice and determines an excellent outcome.

Gigantic large bowel lipoma of hepatic flexure

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.

Is endoscopic resection a correct treatment for atypical gastrointestinal lipomas?

We would like offering our experience about a very rare and underestimated type of gastrointestinal lipoma, which is the lipoma with precancerous or frankly malignant features of the mucosal epithelium, the so-called atypical lipoma. So far, only few cases have been described in the world literature. Recently, we grappled with what we think the first case of atypical colonic lipoma presenting with adenocarcinomatous transformation of the overlying epithelium, as discussed in more detail below. We propose a new definition and classification for this kind of lesions and discuss about their diagnosis, treatment and prognosis.

"Endoscopic Exposure Treatment" for a Small Colonic Lipoma

Lipomas form lobulated masses enclosed by thin and fibrous capsules. Colonic lipomas are usually discovered on colonoscopy, and gentle palpation with biopsy forceps reveals soft nature of the submucosal mass. Submucosal lipomas are usually not fixed to the underlying fascia.

Submucosal lipoma located on the ascending colon

Colonic lipomas are rare tumors of the gastrointestinal system. In this paper, under the light of the literature, we review the symptoms, complications and treatments of colonic lipomas based on a 68 years old female patient applying to our clinic with a colic-like pain in the right lower quadrant and abdominal distention

A rare presentation of colonic polyp

Fig. 1 – Colonoscopy showing a large submucosal polypoidal growth in descending colon. A 60-year-old female, a known diabetic presented with complaints of crampy intermittent pain in left lower abdomen for 15 days associated with one episode of passage of blood stained stools. Colonoscopy revealed a large submucosal polypoidal lesion in the transverse colon [Fig. 1]. CECT abdomen was suggestive of a descending colon lipoma causing proximal colo-colic intussusception [Figs. 2A, B and 3 respectively]. Her serum CEA levels were within normal limits. Intraoperatively, a large 6 cm 4 cm pedunculated polypoidal growth was seen arising from splenic flexure of colon [Fig. 4]. There were no palpable lymph nodes in mesocolon and no evidence of metastasis to liver. She underwent Left Hemicolectomy with colo-colic anastomosis using GIA 80 mm green staplers (Covidien, USA). Postoperative stay in hospital was uneventful. Histopathological examination revealed colonic lipoma. Adult intussusception represents 1% of all bowel obstructions and 5% of all bowel intussusceptions. In contrast to pediatric intussusceptions, which is idiopathic in 90% of cases, 70–90% of adult intussusceptions have an organic cause, 60% developing due to neoplasms (60% malignant and 24–40% benign). Adult colonic intussusceptions are caused by a Article history: Received 14 November 2015 Accepted 16 November 2015 Available online 3 December 2015

Acute intussusception on a lipoma of the left colon: report of a case

Introduction: Lipomas of the colon are rare benign tumors. Colo-colonic intussusception caused by colonic lipoma is more rare. Case report: We report a case of a 52-year-old patient presenting with recurrent colonic obstruction which occurred in recent days. Colonoscopy revealed a large submucosal mass having benign appearance. Abdominal computed tomography scan diagnosed colo-colonic intussusception due to a large lipoma of the sigmoid colon. Diagnosis was confirmed during operative reduction and resection. He had segmental left colectomy. The postoperative course was uneventful. Conclusion: Computed tomography scan and colonoscopy seem important for diagnosing both lipoma and intussusception. The treatment may be surgical or endoscopic.

Rare Case of Intussusception in Adult Due to Colonic Lipoma

Rare Case of Intussusception in Adult Due to Colonic Lipoma

Giant colonic lipoma arising from the ileocecal valve and causing cecal-transverse colonic intussusception

SummaryIntussusception is rare in adults, representing only 1% of bowel obstruction and 5% of all intussusceptions. Previous reports have shown that &gt; 90% of adults diagnosed with intussusception had an identifiable pathological leading point—a malignant tumor in 43–63% of the cases. Colonic lipomas are rare nonepithelial neoplasms, but represent the most common benign tumors in the large intestine. Most colonic lipomas present as submucosal, sessile polypoid masses with intact mucosa, and they rarely produce symptoms when &lt; 2 cm in diameter. However, all the intussuscepted lipomas in the literature had a tumor size &gt; 4 cm in diameter. As the clinical presentations of adult intussusception are not pathognomonic and the image study may not provide a typical presentation, a precise preoperative diagnosis of whether a benign or malignant tumor is causing the colon intussusception can be difficult. Here, we report the case of a 50‐year‐old man who presented with abdominal pain and lower gastrointestinal bleeding and was diagnosed postoperatively with ileocecal valve lipoma with cecal‐transverse colon intussusception. This report emphasizes colonic lipomas &gt; 4 cm in diameter should receive surgical resection before intussusception develops. However, if the nature of the tumor causing colon intussusception cannot be identified before the operation, en bloc resection is recommended as there is a high risk of malignancy spreading.

Submucosal lipoma of colon - A common lesion at an uncommon location

Submucosa of the colon is a rare site for the formation of lipomas, which are usually asymptomatic. A 57 year-old male presented with 25 days-long history of abdominal pain. CT scan showed colo-colonic intussusception. The intussuscepted segment was resected. On histopathology, diagnosis of submucosal lipoma of colon was given. Colonic lipomas often pose a diagnostic challenge. A definitive diagnosis of colonic lipoma is often obtained from histopathological examination of the resected specimen.

Giant Sigmoid Lipoma with Bowel Intussusception

Colonic lipomas are rare mesenchymal tumors that are usually asymptomatic but occasionally can cause acute presentation with GI bleed and intussusception in adults. There overall incidence of this complication is less than 1 %. Most are less than 5 cm and the largest reported in literature is of 10 cm .This case reports a giant colonic lipoma measuring 10x8 cm causing Colo-colonic intussusception. Such large lesions have increased incidence of complications and often are confused with malignancy.

Lipome géant colique : à propos d’un cas à l’origine d’une invagination iléo-colique

The colic intussusception on lipoma is rare. Herein, we report the case of ileocolic intussusception in the right colic lipoma occurred in a 42-years-old woman. The clinical and ultrasonographic aspects directed towards an urinary pathology. The occurrence of an occlusive syndrome and ileocolic intussusception detected by computerized tomographic (CT) scan are consistent with a right hemicolectomy. Furthermore, pathological investigation confirmed the diagnosis of lipoma. Colonic lipoma is rare and its symptoms are not specific. Abdominal CT scan helps for the diagnosis by giving evidence for an intussusception and sometimes for a tumor. Surgical excision followed by pathological examination of the surgical specimen enables the diagnosis of lipoma.

Tu1756 Laparoscopic Treatment of a Giant Colonic Lipoma Presenting As Transverse Colon Intussusception and Lower Intestinal Bleeding: A Case Report

Introduction: Intussusception in adults accounts for 5% of bowel intussusceptions and of 1% of bowel obstructions. Most adult intussusceptions have a demonstrable lead point. Colonic lipomas are a rare cause of intussusception. They are usually small and asymptomatic, with only 30% reaching more than 2 cm at which point they develop symptoms which include anemia, abdominal pain, constipation, diarrhea, bleeding and intussusception. Giant lipoma has been defined as >5 cm in diameter. We present a case of a 6 cm lipoma in the transverse colon causing gastrointestinal bleeding and colo-colonic intussusception. Case: A 31 year-old male patient presented to the emergency room with a one month history of melena and hematochezia, colicky abdominal pain and in the previous 24 hours nausea, vomiting and abdominal distention. Contrast-enhanced CT scan showed a colo-colonic invagination of transverse colon telescoping into the descending colon (Fig. 1). An enema with hidrosoluble contrast was performed with resolution of the intussusception, and an intraluminal oval pediculated mass of 65x41x37 mm with a density of -21 HU was observed at the splenic angle. Colonoscopy reported a submucosal mass with a blood clot causing obstruction of the bowel lumen 55 cm from the anal verge; its proximal and distal margins were marked with blue dye. The patient was taken to surgery and a laparoscopic segmental transverse colectomy was performed. The histopathological report revealed a 6x5x4 cm submucosal lipoma (Fig. 2). The postoperative evolution was uneventful and the patient was discharged on the fifth postoperative day. Discussion: Colonic lipomas are benign nonepithelial tumors which present most commonly in females within the fifth and sixth decades of life. They are most commonly located in the ascending colon (61%), followed by the descending colon (20%), transverse colon (15%) and rectum (3.4%). Symptoms appear in lipomas >2 cm: anemia, colicky abdominal pain, constipation, bleeding and intussusception. Diagnostic methods include CT scan, contrast-enhanced enema, and colonoscopy. CT scan will reveal a regular, well-delimited spherical or ovoid mass of adipose density (-40 to -120 HU). If associated with intussusception it will show a target lesion, a sausage-shaped mass with layers or a mass caused by edema, mural thickening and vascular compromise. Contrast enhanced enema may aid in the reduction of an intussusception and additionally demonstrate a filling defect. Colonoscopy will reveal a submucosal lesion with three characteristic signs: cushion sign, tenting effect, and naked fat sign. Treatment for symptomatic lipomas includes endoscopic excision or surgical resection, with size being the delimiting factor. Segmental colectomy is the gold standard and may be performed laparoscopically.