Colonoscopic-assisted laparoscopic resection of a colon lipoma

Laparoscopic resection of colonic lipomas: When and why?

PATIENT

Male, >60 FINAL DIAGNOSIS: Colonic lipoma Symptoms: Rectal bleeding • abdominal pain • fatique • abdominal distention

MEDICATION

- Clinical Procedure: Laparoscopic resection Specialty: General surgery.

OBJECTIVE

We aimed to review and discuss the clinical picture and management of 4 patients who underwent laparoscopic colonic resection with a definitive pathology of colonic lipoma.

BACKGROUND

Colonic lipomas are rare benign nonepithelial tumors of the colon. They begin to be symptomatic when they reach a certain size, although the presentation can vary. Different endoscopic and surgical treatment strategies have been reported in the literature.

CASE REPORTS

Four male patients who underwent laparoscopic colonic resection and had definitive diagnosis of colonic lipoma were included in this report. All patients were over 60 years old. The first case presented with massive rectal bleeding. Obstructive symptoms and intermittent bleeding were prominent in the second and third cases. Abdominal pain and discomfort was present in the forth case. In the first 2 cases, abdominal CTs were suggestive of colonic lipoma and laparoscopic ileocecal resection was performed. However, malignancy could not be ruled out in the other 2 cases due to large size and heterogeneous appearance of the lesions and inconclusive endoscopic biopsies consisted of ulcer with exudate and inflammatory cells. Laparoscopic left and right hemicolectomy was performed in the third and forth cases, respectively. There were no complications in any patients.

CONCLUSIONS

Laparoscopic resection can be the first choice in treatment of colonic lipomas with various presentations. Wider resections should be considered in cases with uncertain diagnosis.

Giant ulcerated lipoma of the colon causing iron deficiency anemia successfully treated with endoscopic ultrasound-assisted resection

Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.

Cecal lipoma with pseudomalignant features: A case report and review of the literature

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.