A colonic submucosal lipoma presenting with recurrent intestinal obstruction attacks

Solitary lipoma of ileocaecal valve mimicking Crohn's disease: A case report of a challenging diagnosis for a rare benign tumor of the intestinal tract

INTRODUCTION AND IMPORTANCE

Symptomatic ileocaecal lipomas is a fascinating disease, it represents a distinctive subtype of bowel lipomas for two main reasons: it is so rare that its exact incidence is unknown, second its clinical and radiological features are so unspecific that it remains a challenging diagnosis. In terms of treatment surgical resection is indicated when doubting malignant origin, or in case of symptomatic lipomas. Through anatomopathological findings, diagnosis can be confirmed.

CASE PRESENTATION

We herein report a case of an obstructive lipoma of the ileocaecal valve mimicking Crohn's disease, presented as a case of small bowel obstruction evolving for days without clinical, biological, or radiological signs of severity. After overcoming the acute phase, a series of clinical and radiological findings were in favor of inflammatory origin whereas endoscopic investigations showed a fibrotic stenosed ileocaecal valve. The patient underwent ileocaecal resection with primary anastomosis. Anatomopathological reports confirmed the diagnosis of lipoma without any signs of malignancy. No complications were observed.

CLINICAL DISCUSSION

Symptomatic ileocaecal lipoma is a rare pathology, with unspecific signs in clinical examination and radiological features. Surgical management is not common practice. It is reserved for symptomatic tumors, or when in doubt of malignant origin.

CONCLUSION

Amongst benign tumors, ileocaecal lipomas are a rare entity. Due to its misleading symptoms, achieving a positive diagnosis can be challenging. The main problem of these tumors is their differential diagnosis with Crohn's disease, like our case, therefore leading to surgical resection to confirm or infirm malignancy.

Clinicopathological features and management of colonic lipomas: Case reports

INTRODUCTION

Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management.

PATIENT CONCERNS

In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia.

DIAGNOSIS

Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis.

INTERVENTIONS

Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma.

OUTCOMES

Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up.

CONCLUSION

Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful.

Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma: A case report

RATIONALE

Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published.

PATIENT CONCERNS

We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5 × 4.5 × 3.5 cm) was detected at the 15th centimetre of the anal canal via an electronic colonoscope. At the initial part of the rectum, intussusception caused by a 6.5-cm fat-density mass was observed via abdominal contrast-enhanced computed tomography.

DIAGNOSIS

Upper rectal intussusception caused by a giant rectal lipoma.

INTERVENTIONS

Due to the large size of the polyp, an endoscopic polypectomy could not be performed. We performed laparoscopic segmental resection of the rectum (with preservation of the left colic artery [LCA]).

OUTCOMES

The patient was discharged on the 7th postoperative day without any complications, was monitored on a regular basis at our outpatient department and was free of symptoms at a 3-month follow-up visit.

LESSONS

Laparoscopic segmental resection of the rectum with LCA preservation is safe and feasible for the treatment of upper rectal intussusception caused by a giant rectal lipoma.

Large ileocecal submucosal lipoma presenting as hematochezia, a case report and review of literature

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Ileocecal lipomas present typically with intussusception.There are only few reported cases of ileocecal lipomas presenting as lower GI bleeding.

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Histopathological evaluation remains the gold standard in precise diagnosis.

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The treatment of colonic lipomas is debatable among specialists.

Introduction

Colonic lipomas are rare subepithelial benign tumors affecting mainly middle-aged women. They are usually asymptomatic and, hence, are discovered incidentally on autopsy, surgery, or colonoscopy. There is a wide range of presentations like abdominal pain, bleeding per rectum, intussusception, etc. The latter picture constitutes the usual presentation of an ileocecal lipoma. Only few cases of ileocecal lipomas presenting as lower GI bleeding have been reported in the literature.

Presentation of case

We present a case of an adult female patient who was admitted to our institution complaining of hematochezia and right lower quadrant pain. She was found to have chronic anemia. She was investigated by CT scan of the abdomen & pelvis and by colonoscopy which showed a fungating, submucosal mass with ulcerated base near the ileocecal valve. She underwent a colonic resection. The pathology came out as a submucosal benign pedunculated ileocecal lipoma.

Discussion

Colonic lipomas represent 4% of benign lesions of the gastrointestinal tract. They are usually asymptomatic hence are often discovered incidentally on colonoscopy, surgery or autopsy. The definitive diagnosis is made by pathological evaluation. Colonic lipomas are usually treated if they are symptomatic or there is any suspicion of malignancy. The treatment modalities include endoscopic and surgical resection.

Conclusion

We, hereby, describe a case of benign ileocecal lipoma that presented with hematochezia which is an unusual presentation. Also, there is a great controversy regarding the treatment of colonic lipomas. In this article, we tried to answer several questions concerning the management of ileocecal lipomas.

Adult ileo-ileo-caecal intussusception: case report and literature review

Adult intussusception is a rare entity accounting for only 5% of all intussusceptions and causes approximately 1% of all adult intestinal obstructions. Unlike paediatric intussusceptions which are usually idiopathic, there is usually a lead point pathology which might be malignant in up to 50% cases. We present an unusual case of adult intussusception which was not diagnosed on any investigation including computerized tomographic (CT) scan and magnetic resonance imaging (MRI). It was a case of ileo-ileo-cecal intussusception caused by a large lipoma 38 mm × 43 mm × 61 mm. It was treated by emergency laparotomy for acute intestinal obstruction. A conservative resection with ileostomy was performed with good postoperative recovery.