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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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2
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Kobayashi R, Inoue K, Hirose R, Doi T, Harusato A, Dohi O, Yoshida N, Uchiyama K, Ishikawa T, Takagi T, Yasuda H, Konishi H, Morinaga Y, Itoh Y. Obscure gastrointestinal bleeding from a large jejunal lipoma treated using an endoscopic unroofing technique with double balloon enteroscopy: a case study. Clin J Gastroenterol 2023; 16:32-38. [PMID: 36369458 DOI: 10.1007/s12328-022-01724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/15/2022] [Indexed: 11/13/2022]
Abstract
Small intestinal lipomas are rare, but may cause obscure gastrointestinal bleeding. The endoscopic unroofing technique excises only the upper third of the lipoma and allows both histological confirmation and complete treatment with minimal risk of perforation. We present a rare case of obscure gastrointestinal bleeding caused by a jejunal lipoma. A 75-year-old man on antiplatelet therapy presented to our department with melena and anemia. Computed tomography revealed he had a 45-mm jejunal submucosal tumor with fat attenuation. Endoscopic resection using an endoscopic unroofing technique with double balloon enteroscopy was successfully performed. The tumor was confirmed to be a lipoma.
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Affiliation(s)
- Reo Kobayashi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Ryohei Hirose
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Toshifumi Doi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Akihito Harusato
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Naohisa Yoshida
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hiroaki Yasuda
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
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3
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Chen ZH, Lv LH, Pan WS, Zhu YM. Spontaneous expulsion of a duodenal lipoma after endoscopic biopsy: A case report. World J Gastroenterol 2022; 28:5086-5092. [PMID: 36160650 PMCID: PMC9494927 DOI: 10.3748/wjg.v28.i34.5086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign submucosal tumors of mature adipocytes that arise mainly in the colon and stomach, sometimes in the ileum and jejunum, and rarely in the duodenum. Patients with symptomatic lipomas require endoscopic or surgical treatment. Spontaneous expulsion of lipomas after biopsy is a rare condition that has limited case reports.
CASE SUMMARY A 56-year-old man presented to our hospital with intermittent postprandial epigastric fullness. Esophagogastroduodenoscopy (EGD) revealed a 10-mm soft yellowish submucosal lesion with the “pillow sign,” located in the second portion of duodenum. Endoscopic ultrasonography (EUS) using a 12-MHz catheter probe showed a hyperechoic, homogenous, and round solid lesion (OLYMPUS EUS EU-ME2, UM-DP12-25R, 12-MHz radial miniprobe, Olympus Corporation, Tokyo, Japan). Deep biopsy was performed using the bite-on-bite technique with forceps. Histological examination was compatible with submucosal lipoma. The lesion spontaneously expelled 12 d after the biopsy. Follow-up EUS performed after 2 mo confirmed this condition.
CONCLUSION Deep biopsy could lead to spontaneous GI lipoma expulsion. This might be the first step in lipoma diagnosis and treatment.
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Affiliation(s)
- Zhi-Hao Chen
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Affiliated Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Li-Hong Lv
- Department of Gastroenterology, Xianju County People’s Hospital, Taizhou 317300, Zhejiang Province, China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Affiliated Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yi-Miao Zhu
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Affiliated Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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Erginoz E, Uludag SS, Cavus GH, Zengin K, Ozcelik MF. Clinicopathological features and management of colonic lipomas: Case reports. Medicine (Baltimore) 2022; 101:e29004. [PMID: 35451395 PMCID: PMC8913087 DOI: 10.1097/md.0000000000029004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Ergin Erginoz
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Server Sezgin Uludag
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Gokce Hande Cavus
- Department of Pathology, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kagan Zengin
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Faik Ozcelik
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
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5
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Bronswijk M, Vandenbroucke AM, Bossuyt P. Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety. United European Gastroenterol J 2020; 8:1147-1154. [PMID: 32746773 DOI: 10.1177/2050640620948661] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Various techniques have been described for endoscopic resection of large symptomatic colon lipomas. Lipoma unroofing might provide a safer, more time efficient and easier technique compared to dissection-based techniques, endoscopic mucosal resection (EMR) or loop-assisted resection. The aim of this systematic review was to compare efficacy and safety (endoscopic resolution rates, clinical remission rates and adverse events) of lipoma unroofing with respect to dissection-based techniques, EMR or loop-assisted resection. METHODS As most outcomes were binary in nature and several outcomes did not occur in some studies, routine calculation of standard errors in outcome probability was not possible. Therefore, original patient data were extracted, after which efficacy and safety were compared. RESULTS Twenty four studies met the selection criteria, which encompassed 77 lesions (46.8% female, mean age 63 years (interquartile range (IQR) 53-72 years), mean size 45.4 mm (IQR 30.0-60.0 mm). Ten patients underwent unroofing (13.0%), whereas 7 (9.1%), 31 (40.3%) and 29 patients (37.7%) underwent dissection-based techniques, EMR and loop-assisted-snare resection, respectively. Endoscopic resolution rates were 60%, 100% (p = 0.103), 93.6% (p = 0.024) and 93.1% (p = 0.028). Clinical remission rates were identical in all four groups (100%). Amongst patients who underwent EMR and loop-assisted techniques, adverse events were identified in 12.9% (p = 0.556) and 13.8% (p = 0.556), respectively, compared to none in the unroofing and dissection-based resection group. CONCLUSIONS In patients with large colon lipomas, endoscopic treatment by unroofing, dissection-based resection, EMR and loop-assisted resection provided similar clinical remission rates. Amongst patients undergoing EMR and loop-assisted resection, increased endoscopic resolution rates were seen at the expense of more adverse events, although the latter did not reach statistical significance. Until more reliable comparative data are available, the most optimal resection technique should rely on local expertise and patient profile.
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium
| | | | - Peter Bossuyt
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
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6
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Affiliation(s)
- Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Okada M, Sakamoto H, Hayashi Y, Yano T, Shinozaki S, Sunada K, Lefor AK, Yamamoto H. Curative endoscopic treatment of intussusception due to a giant colonic lipoma using a wedged balloon and ligation with detachable snares. Clin J Gastroenterol 2019; 12:320-324. [PMID: 30707403 DOI: 10.1007/s12328-019-00943-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
A 67-year-old woman presented with symptoms of bowel obstruction. Radiographic and ultrasonographic findings suggested colo-colonic intussusception caused by a colonic lipoma. Colonoscopy with an endoscope tip balloon was performed for reduction. The intussusception was partially reduced by injecting dilute contrast media with a wedged inflated balloon at the endoscope tip. For definitive treatment of the polyp, ischemia was induced using a detachable snare. The abdominal pain well improved after endoscopic treatment. However, ultrasonography suggested a residual lesion. Another detachable snare was applied to the stalk on day 6. A large amount of dark-red necrotic tissue was passed per anus the following day. One month later, complete scarring of the site was confirmed colonoscopically. This is the first report of curative endoscopic treatment of an intussusception due to a giant colonic lipoma with detachable snares after the reduction with a wedged balloon of colonoscope tip.
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Affiliation(s)
- Masahiro Okada
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan
| | - Hirotsugu Sakamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan
| | - Yoshikazu Hayashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan
| | - Tomonori Yano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan
| | - Satoshi Shinozaki
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan.,Shinozaki Medical Clinic, Utsunomiya, Japan
| | - Keijiro Sunada
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Tochigi, Japan.
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Tomiki Y, Niwa K, Nagayasu K, Okazawa Y, Ito S, Ichikawa R, Ro H, Ishiyama S, Sugimoto K, Sakamoto K. Two Patients with Large Colonic Lipomas for which Endoscopic Unroofing was Ineffective. Case Rep Gastroenterol 2016; 10:538-544. [PMID: 27843431 PMCID: PMC5091224 DOI: 10.1159/000450542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/31/2016] [Indexed: 12/18/2022] Open
Abstract
Endoscopic unroofing is effective for treating large colonic lipomas. However, additional endoscopic resection is occasionally required when the outcomes of initial unroofing are incomplete. The colonoscopy of an 82-year-old woman with abdominal pain revealed a yellowish lipoma of about 20 mm in the transverse colon. The mass was treated by unroofing, but a follow-up colonoscopy 5 days later revealed residual lipoma. One month later, the regenerated surface had become covered with mucosa, and the status of the lipoma had returned to that before unroofing. The colonoscopy of a 74-year-old man with abdominal pain and melena revealed a 50-mm-wide protruding lipoma in the transverse colon. The mucosa of the upper third of the lipoma was excised using an electric knife and snare, which allowed the immediate partial drainage of adipose tissue. Unroofing proceeded, but 7 days later, the unroofed surface had become coated with a white substance, and the residual lipoma required additional endoscopic resection. Colonic lipomas are often asymptomatic. However, patients with abdominal pain and hemorrhage should be treated in consideration of complete resection, but not by unroofing, which could leave a residual tumor. Drainage should be confirmed after unroofing and any residual lipoma should be treated by additional resection.
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Affiliation(s)
- Yuichi Tomiki
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koichiro Niwa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kiichi Nagayasu
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yu Okazawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shingo Ito
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ryosuke Ichikawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hisashi Ro
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Lee JM, Kim JH, Kim M, Kim JH, Lee YB, Lee JH, Lim CW. Endoscopic submucosal dissection of a large colonic lipoma: Report of two cases. World J Gastroenterol 2015; 21:3127-3131. [PMID: 25780315 PMCID: PMC4356937 DOI: 10.3748/wjg.v21.i10.3127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/08/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
A colonic lipoma is a very rare benign tumor that is usually asymptomatic and is found incidentally by colonoscopy. Patients with a large colonic lipoma may present with symptoms such as abdominal pain, bleeding, and colonic obstruction or intussusceptions. We report two patients with large colonic lipomas and symptoms. Standard endoscopic submucosal dissection (ESD) was performed to remove the lipomas instead of conventional surgical bowel resection. No complications were observed during or after the procedure. The tumors were resected en bloc, and the patients were discharged 2 d after ESD with a regular diet. The results indicate that ESD can be applied as safe and effective treatment for a large colonic lipoma.
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Chehade HHEH, Zbibo RH, Nasreddine W, Abtar HK. Large ileocecal submucosal lipoma presenting as hematochezia, a case report and review of literature. Int J Surg Case Rep 2015; 10:1-4. [PMID: 25770697 PMCID: PMC4429855 DOI: 10.1016/j.ijscr.2015.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 01/11/2023] Open
Abstract
Ileocecal lipomas present typically with intussusception.There are only few reported cases of ileocecal lipomas presenting as lower GI bleeding. Histopathological evaluation remains the gold standard in precise diagnosis. 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.
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Affiliation(s)
| | | | - Walid Nasreddine
- Makassed General Hospital, Department of Gastroenterology, Beirut, Lebanon.
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11
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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: 5] [Impact Index Per Article: 0.6] [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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