Loop-and-let-go technique for the management of symptomatic large colonic lipoma

Colonoscopy-assisted laparoscopic wedge resection for a large symptomatic colonic lipoma

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.

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.