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1
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Bacha D, Kammoun N, Mallek I, Gharbi L, Lahmar A, Slama SB. Pedunculated colonic lipoma causing adult colo-colic intussusception: A case report and literature review. Int J Surg Case Rep 2024; 123:110242. [PMID: 39245015 PMCID: PMC11409040 DOI: 10.1016/j.ijscr.2024.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/29/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024] Open
Abstract
INTRODUCTION Colo-colonic intussusception (CI) in adults is rare, usually caused by malignant conditions. Nonmalignant tumors, like colonic lipomas (CLs), can also be an underlying cause. CASE REPORT We report an unusual case of a 62-year-old man admitted to the emergency department with acute abdominal symptoms. The CT scan confirmed the colonic obstruction, causing significant distention in the transverse and right colon. It also revealed an intraluminal pedunculated colonic mass with fatty density. Peroperatively, a descending colon intussusception was noted. We performed a left colon resection with a double colostomy on the left flank. The postoperative follow-up was uneventful. Pathologic examination of the surgical specimen revealed two lipomas. One of them was pedunculated and protruded into the colonic lumen causing the intussusception. DISCUSSION We conducted a literature review of adult CLs complicated by CI, covering the period from January 1900 to June 2024, including 203 cases. We excluded lipomas exclusive to the small intestine and ileocecal valvula. Our analysis focused on the clinical and pathological characteristics of these cases, as well as the available management options. CONCLUSION Colonic intussusception due to lipomas are uncommon with a challenging preoperative diagnosis despite the evolution of imaging procedures. We aimed by our case to highlight such pathology and to study its features and the possibilities of its management.
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Affiliation(s)
- Dhouha Bacha
- Pathology department, University Hospital Mongi Slim, La Marsa, Tunisia
| | | | - Ines Mallek
- Pathology department, University Hospital Mongi Slim, La Marsa, Tunisia
| | | | - Ahlem Lahmar
- Pathology department, University Hospital Mongi Slim, La Marsa, Tunisia
| | - Sana Ben Slama
- Pathology department, University Hospital Mongi Slim, La Marsa, Tunisia
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2
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Hanevelt J, de Vos Tot Nederveen Cappel WH, Ten Kate FJC, van Westreenen HL. Colonoscopy-assisted laparoscopic wedge resection for a large symptomatic colonic lipoma. BMJ Case Rep 2024; 17:e258947. [PMID: 38663897 PMCID: PMC11043755 DOI: 10.1136/bcr-2023-258947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
A colonic lipoma is an uncommon lesion that is linked with clinical symptoms in only a small portion of patients. Patients with large lipomas are often referred for major surgery, which is associated with significant morbidity and mortality. In this case, we described a female patient with recurrent episodes of gastrointestinal blood loss, abdominal pain and colocolic intussusceptions due to a large, lumen-filling, obstructive lipoma in the splenic flexure. On abdominal CT, a lesion of 3.6 cm was visualised with a fat-like density without solid components. Considering its benign nature, we intended to preserve the colon by deroofing the upper part of the lesion and then performing a colonoscopy-assisted laparoscopic wedge resection. During reassessment, auto-amputation of part of the lesion was observed, most likely as a result of long-lasting mechanical effects, which made it possible to perform solely a wedge resection with an excellent outcome.
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Affiliation(s)
- Julia Hanevelt
- Gastroenterology and Hepatology, Isala, Zwolle, Netherlands
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3
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Moschetta M, Virelli R, Laricchia F, Alberotanza V, Telegrafo M, Angelelli G, Stabile Ianora AA. Lipoma of the transverse colon covered by tubulovillous adenoma: a rare indication for surgical treatment. G Chir 2019; 39:63-66. [PMID: 29549684 DOI: 10.11138/gchir/2018.39.1.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Lipomas of the digestive tract are rare benign tumours which, in most cases, are totally asymptomatic. Because of their localization within the intestinal wall, endoscopy may be completely negative so contrast-enhanced computed tomography (CT) is very important for detecting and typing these lesions. The case of a 49-year-old man with abdominal pain is presented. Colonoscopy and biopsy of a polypoid lesion on the right colonic flexure concluded for tubulovillous adenoma. The subsequent CT showed a polylobate lesion of 5 cm in diameter with predominant fat density causing luminal sub-stenosis. Histological examination of the surgical specimen confirmed the presence of a voluminous submucosal lipoma. CT allows to diagnose lipomas of the large bowel thanks to the density measurement (between -40 and -120 Hunsfield Units) with an accurate detection of the site and nature of lumen stenosis.
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4
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Intestinal Obstruction Caused by Ileocolic and Colocolic Intussusception in an Adult Patient with Cecal Lipoma. Case Rep Surg 2017; 2016:3519606. [PMID: 28044120 PMCID: PMC5164886 DOI: 10.1155/2016/3519606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
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.
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5
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Kopáčová M, Rejchrt S, Bureš J. Unroofing Technique as an Option for the Endoscopic Treatment of Giant Gastrointestinal Lipomas. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 58:115-8. [PMID: 26960822 DOI: 10.14712/18059694.2016.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gastrointestinal lipomas are usually asymptomatic, detected incidentally. However, they can cause severe symptoms such as obstruction, invagination, and bleeding. The transsection of an infarcted or large lipoma by needle sphincterotome (needle knife) and/or snare polypectomy of the upper part of the tumour is an option for the endoscopy treatment of giant infarcted lipomas. Cutting a top of lipoma (unroofing technique) allowed flow out of adipose tissue from the lipoma.
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Affiliation(s)
- Marcela Kopáčová
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic.
| | - Stanislav Rejchrt
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
| | - Jan Bureš
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
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6
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Affiliation(s)
- Alexandre Dias Mançano
- MD, Radiologist at Radiologia Anchieta - Hospital Anchieta,
Coordinator for Medical Residency at Hospital Regional de Taguatinga, Taguatinga, DF,
Brazil
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7
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Computerized tomography providing definitive diagnosis of colonic lipoma: a case series. Surg Laparosc Endosc Percutan Tech 2013; 23:e232-4. [PMID: 24300939 DOI: 10.1097/sle.0b013e31828e3e37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lipomas are common benign mesenchymal tumors. They can develop in virtually all organs throughout the body. Colonic lipomas are uncommon, benign, submucosal adipose tumors that are usually asymptomatic. Large lipomas can cause symptoms such as constipation, abdominal pain, rectal bleeding, and intussusception. We report a case series of 2 colonic submucosal lipomas with varying clinical presentations, elaborating the importance of computerized tomography imaging in the diagnosis and preoperative planning.
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8
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Lee JY, Ye BD. [Colonic intussusceptions caused by a giant lipoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012. [PMID: 23193560 DOI: 10.4166/kjg.2012.60.3.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jae Yeon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Zarrin-Khameh N, Haas EM, Ro J, Thrall MJ. Lipomatosis coli, a mimicker of familial polyposis. Ann Diagn Pathol 2011; 17:210-3. [PMID: 22056034 DOI: 10.1016/j.anndiagpath.2011.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 07/25/2011] [Accepted: 08/09/2011] [Indexed: 10/15/2022]
Abstract
Multiple intestinal lipomas (lipomatous polyposis) are quite rare, and they can be quite challenging to diagnose because this condition may be clinically confused with familial adenomatous polyposis with a suggestive family history. Herein, we present a case of lipomatous polyposis that was presented with abdominal pain and, in colonoscopy, had more than 100 polyps. The patient was admitted for surgery with diagnosis of familial polyposis. Resected colon specimen had multiple polyps ranging from 0.1 to 1.5 cm. Microscopically, the polyps were composed of mature adipose tissue with normal overlying mucosa. There were also increased fat cells in the submucosa of the colon adjacent to the polyps. Lipomatous polyposis rarely occurs and can be confused with familial polyposis. Polypectomy is a simple and cost-effective procedure to help in diagnosis and prevent a major surgery.
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Affiliation(s)
- Neda Zarrin-Khameh
- Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, USA.
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10
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Kouritas VK, Baloyiannis I, Koukoulis G, Mamaloudis I, Zacharoulis D, Efthimiou M. Spontaneous expulsion from rectum: a rare presentation of intestinal lipomas. World J Emerg Surg 2011; 6:19. [PMID: 21668995 PMCID: PMC3130650 DOI: 10.1186/1749-7922-6-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Accepted: 06/13/2011] [Indexed: 12/11/2022] Open
Abstract
Lipomas are rare, subserosal, usually solitary, pedunculated small lesions appearing mainly in the large intestine with a minimal malignancy potential. They usually run asymptomatic and become symptomatic when they become enlarged or complicated causing intestinal obstruction, perforation, intusucception or massive bleeding. In rare cases they can be self-detached and expulsed via the rectum as fleshy masses. This event mainly occurs in large, pendunculated lipomas which detach from their pedicle. The reason for this event remains in most of cases unclear although in some cases a predisposing factor does exist. Abdominal pain and obstructive ileus may be observed while in many cases bleeding occurs. The expulsed mass sets the diagnosis and in most of the cases all symptoms subside. Diagnosis is rarely established before surgery with the use of barium enema, computed tomography and colonoscopy which additionally provides measures of treatment and diagnosis. In atypical cases though, in cases where the malignancy can not be excluded or in complicated cases, surgery is recommended. Usually the resection of the affected intestinal part is adequate. If during surgery a lipoma is encountered simple lipomatectomy seems also to be adequate.
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11
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Martellucci J, Civitelli S, Tanzini G. Transanal resection of rectal lipoma mimicking rectal prolapse: description of a case and review of the literature. ISRN SURGERY 2011; 2011:170285. [PMID: 22084744 PMCID: PMC3196962 DOI: 10.5402/2011/170285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 03/16/2011] [Indexed: 11/30/2022]
Abstract
Submucosal lipomas of the large bowel are uncommon. Occasionally, they occur in the rectum and may cause aspecific symptoms; presentation with rectal prolapse is very unusual and may lead to a misdiagnosis of simple mucosal prolapse. The paper describes an additional case of a prolapsing rectal mass that led to diagnosis and surgical treatment of a rectal lipoma under local anesthesia.
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Affiliation(s)
- Jacopo Martellucci
- Department of General Surgery, University of Siena 53100 Siena, Italy
- Chirurgia Generale I, Dipartimento di Chirurgia, Ospedale Policlinico Le Scotte, Viale Bracci 16, 53100 Siena, Italy
| | | | - Gabriello Tanzini
- Department of General Surgery, University of Siena 53100 Siena, Italy
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12
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Sandhu PS, Bansiwal RK, Attri AK, Mittal R. Diffuse colonic lipomatosis, presenting as perforation peritonitis and mimicking carcinoma colon. Indian J Surg 2010; 73:155-7. [PMID: 22468069 DOI: 10.1007/s12262-010-0204-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 03/08/2009] [Indexed: 11/27/2022] Open
Abstract
Lipomas and lipomatosis of colon are rare in clinical practice. We herein report a case of diffuse colonic lipomatosis, fifth such case in literature which presented as perforation peritonitis, a presentation, never been reported earlier. On laparotomy, the findings suggested malignancy and appropriate surgery was done. Diffuse Colonic Lipomatosis, a rare and benign condition mimicks malignancy and should be kept as a differential diagnosis is unusual cases of colonic perforations.
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13
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Lazaraki G, Tragiannidis D, Xirou P, Nakos A, Pilpilidis I, Katsos I. Endoscopic resection of giant lipoma mimicking colonic neoplasm initially presenting with massive haemorrhage: a case report. CASES JOURNAL 2009; 2:6462. [PMID: 20181161 DOI: 10.1186/1757-1626-0002-0000006462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 02/05/2009] [Indexed: 11/10/2022]
Abstract
Lipomas of the colon are benign tumors that rarely occur. Their size ranges from 2 mm to several cm. They are usually asymptomatic but occasionally they present with clinical manifestations depending on tumor size, localization and complications, which often lead to diagnostic difficulty. A 40-year-old man presented with massive rectal haemorrhage. During colonoscopy a giant polyp of over 50 mm in its bigger diameter, with a thick stalk of 2 cm, located in the transverse colon, was revealed. Endoscopic resection was performed with success. Histologic examination demonstrated a giant lipoma. In this report discussion over endoscopic resection of colonic lipomas mimicking neoplasms is also performed.
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Affiliation(s)
- Georgia Lazaraki
- Department of Gastrointestinal Oncology, Theagenion Cancer Hospital, Al. Simeonidi 2 str, 54007, Thessaloniki, Greece.
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14
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Lazaraki G, Tragiannidis D, Xirou P, Nakos A, Pilpilidis I, Katsos I. Endoscopic resection of giant lipoma mimicking colonic neoplasm initially presenting with massive haemorrhage: a case report. CASES JOURNAL 2009. [PMID: 20181161 PMCID: PMC2827102 DOI: 10.1186/1757-1626-2-6462] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lipomas of the colon are benign tumors that rarely occur. Their size ranges from 2 mm to several cm. They are usually asymptomatic but occasionally they present with clinical manifestations depending on tumor size, localization and complications, which often lead to diagnostic difficulty. A 40-year-old man presented with massive rectal haemorrhage. During colonoscopy a giant polyp of over 50 mm in its bigger diameter, with a thick stalk of 2 cm, located in the transverse colon, was revealed. Endoscopic resection was performed with success. Histologic examination demonstrated a giant lipoma. In this report discussion over endoscopic resection of colonic lipomas mimicking neoplasms is also performed.
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Affiliation(s)
- Georgia Lazaraki
- Department of Gastrointestinal Oncology, Theagenion Cancer Hospital, Al. Simeonidi 2 str, 54007, Thessaloniki, Greece.
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15
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Sockeel P, Massoure MP. [Colonic lipoma and familial multiple lipomatosis: a chance association?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:872-873. [PMID: 18547766 DOI: 10.1016/j.gcb.2008.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 03/21/2008] [Accepted: 03/25/2008] [Indexed: 05/26/2023]
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16
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[Colonic lipoma: case report and literature review]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:521-4. [PMID: 18343069 DOI: 10.1016/j.gcb.2007.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 10/04/2007] [Accepted: 11/12/2007] [Indexed: 02/08/2023]
Abstract
Colonic lipoma is a rare benign tumor infrequently met in clinical practice. We report a case of symptomatic lipoma of the ascending colon in a 61-year-old woman. Diagnosis was suspected on CT scan. Colotomy with lipectomy was performed. The diagnosis was confirmed by histological examination. Reviewing the literature and combining with our experience, we discuss the clinical features, diagnosis and treatment of this uncommon disease.
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17
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Nebbia JF, Cucchi JM, Novellas S, Bertrand S, Chevallier P, Bruneton JN. Lipomas of the right colon: report on six cases. Clin Imaging 2008; 31:390-3. [PMID: 17996601 DOI: 10.1016/j.clinimag.2007.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 04/23/2007] [Indexed: 01/12/2023]
Abstract
We report six cases of lipomas of the right colon, of which one was affected by two lesions. Two cases presented with episodes of partial occlusion; the others did not present with particular symptoms. The diagnoses were based on imaging by computed tomography, which demonstrated an intraluminal formation of fatty density, not associated with tissual components or hypervascularization.
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Affiliation(s)
- Jean-Francois Nebbia
- Service d'Imagerie Médicate, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet 2, route de Saint Antoine de Ginestiére, B.P. 3979, F-06202 Nice Cedex 3, France.
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18
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Koktener A, Erden A. Usefulness of virtual colonoscopy in the diagnosis of symptomatic large colonic lipomas. AUSTRALASIAN RADIOLOGY 2007; 51 Spec No.:B144-6. [PMID: 17875139 DOI: 10.1111/j.1440-1673.2007.01798.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Lipomas of the colon are uncommon tumour of the gastrointestinal tract, but cause diagnostic difficulty when they are symptomatic. We reported two cases of symptomatic, large colonic lipoma. Colonoscopy was incomplete because of the narrowing lumen caused by lipomas. By the help of computed tomography colonography/virtual colonoscopy, colonic lipomas were diagnosed correctly, but also proximal colon was examined.
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Affiliation(s)
- A Koktener
- Department of Radiology, School of Medicine, Fatih University, Ankara, Turkey.
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19
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MURATA I, MUTA K, ITSUNO M, MAKIYAMA K, HARA K, IMAMURA K, TAGUCHI H, MATSUNAGA K, YAMANAKA H. Endoscopic Diagnosis of Intestinal Lipomas. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1992.tb00087.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Ikuo MURATA
- *Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Koki MUTA
- *Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Minoru ITSUNO
- *Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Kazuya MAKIYAMA
- *Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Kohei HARA
- *Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Kazuyuki IMAMURA
- **Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan
| | - Hisao TAGUCHI
- *Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Keiichiro MATSUNAGA
- ***Department of Internal Medicine, Omura City Hospital, Omura, Nagasaki, Japan
| | - Hideo YAMANAKA
- ****Department of Internal Medicine, Izumikawa Hospital, Nagasaki, Japan
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20
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Gürses B, Kabakci N, Akyuz U, Pata C, Taviloglu K, Kovanlikaya I. Imaging features of a cecal lipoma as a lead point for colo-colonic intussusception. Emerg Radiol 2007; 15:133-6. [PMID: 17704958 DOI: 10.1007/s10140-007-0641-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 05/29/2007] [Indexed: 11/25/2022]
Abstract
Intussusception is a rare occurrence in the adult population with most of the cases seen during the childhood period. Compared with the pediatric intussusceptions, there is more often an underlying cause in adults. Lipoma as a lead point for colonic intussusception is rare. Ultrasound may be helpful in the diagnosis, but computed tomography is more reliably used for differential diagnosis. An adult patient with colo-colonic intussusception diganosed with ultrasound and confirmed with computed tomography is presented.
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Affiliation(s)
- B Gürses
- Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey.
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21
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Katsinelos P, Chatzimavroudis G, Zavos C, Pilpilidis I, Lazaraki G, Papaziogas B, Paroutoglou G, Kountouras J, Paikos D. Cecal lipoma with pseudomalignant features: A case report and review of the literature. World J Gastroenterol 2007; 13:2510-3. [PMID: 17552037 PMCID: PMC4146772 DOI: 10.3748/wjg.v13.i17.2510] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, 54635, Thessaloniki, Greece.
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22
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Capra F, Zorcolo L, Scintu F, Mascia R, Casula G. Giant sigmoid lipoma covered by a villous adenoma. Int J Colorectal Dis 2007; 22:563-4. [PMID: 15999249 DOI: 10.1007/s00384-005-0754-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2005] [Indexed: 02/04/2023]
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23
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Tascilar O, Cakmak GK, Gün BD, Uçan BH, Balbaloglu H, Cesur A, Emre AU, Comert M, Erdem LO, Aydemir S. Clinical evaluation of submucosal colonic lipomas: Decision making. World J Gastroenterol 2006; 12:5075-7. [PMID: 16937511 PMCID: PMC4087418 DOI: 10.3748/wjg.v12.i31.5075] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Even lipomas are the most common mesenchymal benign tumors of the gastrointestinal tract, symptomatic colonic presentation is rare. Herein, we evaluated four patients suffering from various size of colonic lipomas and approached by different therapeutic modalities.
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Affiliation(s)
- Oge Tascilar
- Department of Surgery, Zonguldak Karaelmas University, Kozlu-Zonguldak 67600, Turkey
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24
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Sidani SM, Tawil AN, Sidani MS. Extraction of a large self-amputated colonic lipoma: A case report. Int J Surg 2006; 6:409-11. [PMID: 18947813 DOI: 10.1016/j.ijsu.2006.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2006] [Revised: 05/03/2006] [Accepted: 05/09/2006] [Indexed: 12/16/2022]
Abstract
Despite being the most common benign tumor of nonepithelial origin in the colon, colonic lipomas are nonetheless considered a rare occurrence. The minority of patients presenting with symptomatic colonic lipoma are generally treated with resection. We report a case of a symptomatic patient who, on presentation, was found to have a partially obstructing, self-amputated colonic mass on colonoscopy, requiring endoscopic fragmentation to extrude what was later histologically diagnosed to be a lipoma.
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Affiliation(s)
- Shafik M Sidani
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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25
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Huh KC, Lee TH, Kim SM, Im EH, Choi YW, Kim BK, Jung DJ, Choi WJ, Kang YW. Intussuscepted sigmoid colonic lipoma mimicking carcinoma. Dig Dis Sci 2006; 51:791-5. [PMID: 16615005 DOI: 10.1007/s10620-006-3208-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 04/04/2005] [Indexed: 02/08/2023]
Affiliation(s)
- K C Huh
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
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26
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Jelenc F, Brencic E. Laparoscopically assisted resection of an ascending colon lipoma causing intermittent intussusception. J Laparoendosc Adv Surg Tech A 2005; 15:173-5. [PMID: 15898912 DOI: 10.1089/lap.2005.15.173] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Colonic lipomas are relatively uncommon clinical entity, although they are among the most common nonepithelial benign tumors of the colon. They may produce abdominal pain, diarrhea, constipation, hemorrhage, and intussusception. We report a case of a 56-year-old man who was suffering from abdominal pain and 4 weeks of intermittent diarrhea. Ultrasound examination of the abdomen revealed an abdominal mass in the right upper quadrant. Computed tomography showed a well-circumscribed intraluminal mass in the ascending colon, measuring 5 cm in diameter, with density value equal to fat. During laparoscopic surgery we found a colocolic intussusception, which we reduced laparoscopically, and performed a laparoscopically assisted right colectomy. The resected colon revealed a 6 cm wide lipoma within the ascending colon. Histology confirmed the diagnosis of benign lipoma. Aspects of preoperative diagnosis and treatment are discussed, and we review the literature.
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Affiliation(s)
- F Jelenc
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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27
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Adachi S, Hamano R, Shibata K, Yoshida S, Tateishi H, Kobayashi T, Hanada M. Colonic lipoma with florid vascular proliferation and nodule-aggregating appearance related to repeated intussusception. Pathol Int 2005; 55:160-4. [PMID: 15743326 DOI: 10.1111/j.1440-1827.2005.01803.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A unique case of repeatedly intussuscepted colonic lipoma mimicking an epithelial tumor in a 50-year-old man is reported. The tumor was located in the ascending colon and was approximately 5 cm in diameter. Colonoscopic and barium-enema examinations suggested a huge epithelial tumor because of its nodule-aggregating appearance. In contrast, computed tomography examination showed a fatty element in the core of the lesion. The biopsy specimens suggested a primary angiomatous lesion because of its pronounced vascular proliferation. Because the presumed diagnoses based on the examinations were different, the preoperative diagnosis was not confirmed. The tumor was composed of intramural lipoma with a multiple polypoid mucosa overlay. This lesion was unique in that the lipoma appeared to be within the muscularis propria and the multiple polypoid appearance of its covering mucosa. The mucosal changes including florid vascular proliferation, fibromuscular obliteration and epithelial regeneration suggested a reparative process, with ischemic damage due to the effects of intussusception being the most likely event. It should be kept in mind that even a simple lipoma can have a unique appearance reminiscent of epithelial tumor when it repeatedly experiences intussusception.
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Affiliation(s)
- Shiro Adachi
- Department of Pathology, The City Hospital of Ikeda, Ikeda, Japan.
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28
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Vilallonga Puy R, Naval Alvaro J, Masferrer Sala J, Armengol Carrasco M. [Intermittent and subacute intestinal obstruction due to giant lipoma of the colon]. Med Clin (Barc) 2004; 123:638-9. [PMID: 15546529 DOI: 10.1016/s0025-7753(04)74628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Meghoo CAL, Cook PR, McDonough CA, Bowser LK, Waddell BE. Large colonic lipoma with mucosal ulceration mimicking carcinoma. Gastrointest Endosc 2003; 58:468-70. [PMID: 14528235 DOI: 10.1067/s0016-5107(03)00035-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Colin A L Meghoo
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas 79920-5001, USA
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30
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Rogers SO, Lee MC, Ashley SW. Giant colonic lipoma as lead point for intermittent colo-colonic intussusception. Surgery 2002; 131:687-8. [PMID: 12075187 DOI: 10.1067/msy.2002.116409] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Selwyn O Rogers
- Department of Surgery, Brigham and Women's Hospital, Boston, Mass 02115, USA
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31
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Abstract
BACKGROUND Colonic lipomas are benign adipose tumors that rarely cause symptoms. Removal of lipomas 2 cm or greater in diameter has been associated with a greater risk of perforation. Experience with the evaluation and removal of large colonic lipomas with the assistance of EUS to reduce the risk of perforation is reported. METHODS Four patients with large colonic lipomas were evaluated and treated with endoscopic methods. EUS was performed to confirm that the lesion was a lipoma superficial to the muscularis propria. Saline or epinephrine solution was injected at the base of the tumor, which was then resected electrosurgically with a snare. OBSERVATIONS All 4 lesions were successfully removed and histopathologically confirmed to be lipomas (mean maximal diameter 2.8 cm). There were no complications of any procedure. One patient was hospitalized overnight because of abdominal pain that resolved without complication. CONCLUSIONS Large colonic lipomas can be removed safely by electrosurgical snare resection after injection of the base with epinephrine or saline solution. EUS should be used to ensure that the lipoma does not extend into the muscularis propria. Clinical judgment is important in assessing the need to remove these lesions.
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32
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Abstract
The non-inherited gastrointestinal polyposis syndromes represent a group of rare disorders characterized by the presence of multiple, non-adenomatous polyps on the gastrointestinal mucosa occurring in unrelated patients. We present here a review of the clinical and histo- pathological aspects of the syndromes to include the Cronkhite-Canada syndrome, hyperplastic polyposis and lipomatous polyposis. While infrequently encountered, these diseases can have devastating clinical effects that may be aggravated by delays in diagnosis and treatment. Prompt accurate diagnosis and treatment of these uncommon disorders depend on a sound working knowledge of the distinct clinical and pathological features described herein.
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Affiliation(s)
- E M Ward
- Department of Internal Medicine and Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
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33
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Franc-Law JM, Begin LR, Vasilevsky CA, Gordon PH. The Dramatic Presentation of Colonic Lipomata: Report of Two Cases and Review of the Literature. Am Surg 2001. [DOI: 10.1177/000313480106700524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Colonic lipoma with a dramatic presentation requiring urgent operation is a rare occurrence. We report two such cases in conjunction with a review of the literature on colonic lipomata. Clinicopathologic features of two patients who required urgent resection were studied. The preoperative diagnosis of colonic lipoma was suggested on imaging study in one case. A MEDLINE search was conducted with a special goal of revealing cases with a dramatic presentation. One patient presented with rectal bleeding and intussusception related to a partially infarcted 4.5-cm submucosal lipoma of the lower descending colon. The second patient presented with intestinal obstruction related to a near-totally infarcted 6-cm submucosal lipoma at the splenic flexure. In both cases a florid reactive vascular and fibro-/myofibroblastic proliferation and associated hyperplastic mucosal pattern were present at the base and edge of the lipoma. Among 275 previously reported cases of colonic lipoma 28 patients had a dramatic presentation with pain and/or rectal bleeding being the most significant prodromal symptom. In this subset the lipomas tended to be larger, frequently had associated marked necrosis/ulceration, and were less likely to be located in the ascending colon/cecum. Whereas colonic lipomas are relatively common occasional cases present dramatically with massive bleeding, intussusception, or even perforation for which emergency operation is required. Such lipomas usually reveal marked ischemic changes.
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Affiliation(s)
- Jeffrey M. Franc-Law
- Departments of Pathology, The Sir Mortimer B. Davis-Jewish General Hospital and McGill University Montreal, Quebec, Canada
| | - Louis R. Begin
- Departments of Pathology, The Sir Mortimer B. Davis-Jewish General Hospital and McGill University Montreal, Quebec, Canada
| | - Carol-Ann Vasilevsky
- Departments of Colorectal Surgery, The Sir Mortimer B. Davis-Jewish General Hospital and McGill University Montreal, Quebec, Canada
| | - Philip H. Gordon
- Departments of Colorectal Surgery, The Sir Mortimer B. Davis-Jewish General Hospital and McGill University Montreal, Quebec, Canada
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34
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Climent A, Estévez A, Magdalena C, Rouco J, Cerrada L, Rey F. Lipohiperplasia de la válvula ileocecal como causa de abdomen agudo. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71822-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Affiliation(s)
- J G Guillem
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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36
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Catania G, Petralia GA, Migliore M, Cardì F. Diffuse colonic lipomatosis with giant hypertrophy of the epiploic appendices and diverticulosis of the colon. Report of a case and review of the literature. Dis Colon Rectum 1995; 38:769-75. [PMID: 7607042 DOI: 10.1007/bf02048039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE A case of diffuse colonic lipomatosis, dolichosigmoid, hypertrophy of the epiploic appendices and diverticulosis of the colon producing constipation, recurrent sub-occlusive episodes with diarrhea and vomiting, and weight loss is reported. METHODS Careful preoperative assessment of clinical, radiologic, and endoscopic findings suggested the diagnosis. RESULTS A total colectomy, followed by a lateroterminal ileoproctostomy, gave complete relief from symptoms. CONCLUSIONS Of the 12 cases of colonic lipomatosis previously reported, only 2 have isolated involvement of the entire organ, but they do not present lipomatosis of the epiploic appendices.
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Affiliation(s)
- G Catania
- Department of Surgery, University of Catania, Italy
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37
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Kakitsubata Y, Kakitsubata S, Nagatomo H, Mitsuo H, Yamada H, Watanabe K. CT manifestations of lipomas of the small intestine and colon. Clin Imaging 1993; 17:179-82. [PMID: 8364788 DOI: 10.1016/0899-7071(93)90105-v] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Seven cases of lipoma of the intestine demonstrated by computed tomography (CT) are reported. There were three men and four women who ranged in age from 47 to 78 years. The lipomas were in the small intestine in four patients, and in the colon in three. CT documented the characteristic low attenuation (fat density) of these masses in all patients. It is concluded that intestinal lipomas are important indications for CT evaluations.
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Affiliation(s)
- Y Kakitsubata
- Department of Radiology, Miyazaki Medical College, Japan
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38
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Ramírez JM, Ortego J, Deus J, Bustamante E, Lozano R, Dominguez M. Lipomatous polyposis of the colon. Br J Surg 1993; 80:349-50. [PMID: 8472149 DOI: 10.1002/bjs.1800800329] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J M Ramírez
- Department of Surgery, Hospital Clínico Universitario, Zaragoza, Spain
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39
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Wang TK. Adult descending colocolic intussusception caused by a large lipoma. GASTROENTEROLOGIA JAPONICA 1992; 27:411-3. [PMID: 1624083 DOI: 10.1007/bf02777762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adult intussusception is uncommon and varies considerably from the more common occurrence of this disorder in infants and children. Although lipoma represents the most common benign tumor of the colon, it is a relatively rare cause of gastrointestinal symptoms. A rare case of adult intussusception of the descending colon caused by a giant lipoma is presented and discussed.
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Affiliation(s)
- T K Wang
- Surgical Department, Far Eastern Memorial Hospital, Taipei, Taiwan
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40
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Scoggin SD, Frazee RC. Laparoscopically assisted resection of a colonic lipoma. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1992; 2:185-9. [PMID: 1535813 DOI: 10.1089/lps.1992.2.185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Laparoscopic excision of a lipoma of the sigmoid colon is described. The patient's postoperative recovery was rapid and similar to that experienced in patients undergoing laparoscopic cholecystectomy and appendectomy. He enjoyed the benefit of complete surgical excision of his disease while foregoing the postoperative discomfort and morbidity of open celiotomy. Because the majority of lipomas are submucosal, endoscopic removal carries an inherently high risk. For those lesions amenable to it, laparoscopic colotomy and excision offers a viable alternative to open laparotomy excision of colonic lipomas and polyps in general.
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Affiliation(s)
- S D Scoggin
- Department of Surgery, Scott & White Clinic, Temple, TX
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41
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Kitamura K, Kitagawa S, Mori M, Haraguchi Y. Endoscopic correction of intussusception and removal of a colonic lipoma. Gastrointest Endosc 1990; 36:509-11. [PMID: 2227328 DOI: 10.1016/s0016-5107(90)71128-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K Kitamura
- Department of Surgery II, Kyushu University, Faculty of Medicine, Japan
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42
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Matsumoto T, Iida M, Matsui T, Hirakawa M, Shiraishi A, Yao T, Fujishima M. Submucosal tumors of the terminal ileum managed by endoscopic polypectomy. Gastrointest Endosc 1990; 36:505-9. [PMID: 2227327 DOI: 10.1016/s0016-5107(90)71127-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- T Matsumoto
- Department of Internal Medicine II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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43
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Abstract
Colonic lipomas are benign adipose tumors which are usually submucosal. With the increase in the number of endoscopic procedures being performed, these tumors are often detected incidentally at colonoscopy. Although the risks of removing these tumors have been recognized, numerous reports have documented safe removal by snare electrocautery. We have reviewed the clinical outcome and the endoscopic and histopathologic features of seven lipomas that were endoscopically removed over a 5-year period. Four patients recovered uneventfully, while three patients (42.8%) developed colonic perforation after the polypectomy. In the latter group, the lipomas were significantly larger than they were in the patients who did not develop colonic perforation (1.9 +/- 0.4 and 4.2 +/- 0.7 cm, respectively; p = 0.048). Furthermore, the polypectomy specimens from those patients who developed perforation all contained significant muscularis propria. Lipomatous polyps that are identified at endoscopy to be greater than or equal to 2 cm in diameter and to have a limited pedicle are at the greatest risk for endoscopic perforation.
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Affiliation(s)
- S A Pfeil
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
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