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Yamazaki H, Minato Y, Madhu D, Iida T, Banjyoya S, Kimura T, Furuta K, Nagae S, Itou Y, Takeuchi N, Takayanagi S, Kimoto Y, Kano Y, Sakuno T, Ono K, Ohata K. Extraction of terminal ileal lipomas to cecum can facilitate endoscopic resection: A case series with video. DEN OPEN 2025; 5:e375. [PMID: 38694538 PMCID: PMC11058687 DOI: 10.1002/deo2.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/04/2024]
Abstract
Large ileal lipomas over 2 cm can cause symptoms, that may require a resection. Due to the narrow lumen and thin walls of the ileum, endoscopic treatments can have a high risk of adverse events and require technical expertise, thus surgical resection is currently the mainstay of treatment. To overcome the technical challenges, we developed a novel method to endoscopically resect terminal ileal lipomas. The technique involves extracting the lesion into the cecum, which creates sufficient space to maneuver, and a better field of view. The lipoma is resected with endoscopic mucosal resection or endoscopic submucosal dissection. The appearance of the lipoma protruding out of the ileocecal valve resembles that of a tongue sticking out of the mouth, thus we named this the "tongue out technique". To assess the technical feasibility of this method, we retrospectively analyzed seven cases of terminal ileal lipoma that were endoscopically resected using the "tongue out technique" at NTT Medical Center Tokyo between January 2017 and October 2023. Technical success was 100% and en bloc resection was achieved in all cases. The median size was 31 (14-55) mm. Three cases were resected with endoscopic mucosal resection while endoscopic submucosal dissection was performed on the other four cases. There was one case of delayed post-endoscopic mucosal resection bleeding, which was caused by clip dislodgement. There were no perforations. No recurrence of the lipoma or associated symptoms have been observed. This new technique can allow more ileal lipomas to be treated with minimally invasive and organ-preserving endoscopic procedures.
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Affiliation(s)
- Hiroshi Yamazaki
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yohei Minato
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Deepak Madhu
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Toshifumi Iida
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Susumu Banjyoya
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Tomoya Kimura
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Koichi Furuta
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Shinya Nagae
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yohei Itou
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Nao Takeuchi
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Shunya Takayanagi
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yoshiaki Kimoto
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yuki Kano
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Takashi Sakuno
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Kohei Ono
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Ken Ohata
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
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2
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Uygur FA, Kuloğlu E, Aydin G, Muhtaroğlu A, Dülger AC. Characterizing colon lipomas: Insights from a retrospective analysis of clinical presentation and management strategies. Medicine (Baltimore) 2024; 103:e38287. [PMID: 38787996 PMCID: PMC11124602 DOI: 10.1097/md.0000000000038287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
This retrospective study aims to examine the characteristics and treatment approaches of colon lipomas, which are benign tumors found in the colon. We analyzed a cohort of 25 patients, focusing on demographic characteristics, clinical presentation, location and size of the lipoma, concomitant pathologies, and treatment methods. The average age of the patients was 67.3 years, with 36% being male and 64% female. The majority of lipomas were located in the ascending colon (52%), and their median size was 2 cm. The predominant presenting symptom was constipation, affecting 83.3% of the symptomatic patients. Surgical resection was undertaken in only 1 patient due to obstruction. Statistically significant differences were observed between symptomatic and asymptomatic patients regarding various parameters, including the size of the lipoma (P = .033). Colon lipomas are generally benign and frequently asymptomatic but may necessitate different treatment approaches depending on their size, location, and the presence of symptoms. Further studies are imperative to refine treatment strategies and enhance patient care outcomes.
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Affiliation(s)
- Furkan Ali Uygur
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Ersin Kuloğlu
- Department of Internal Medicine, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Gökhan Aydin
- Gastroenterology Clinic, İskenderun State Hospital, Hatay, Turkey
| | - Ali Muhtaroğlu
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Ahmet Cumhur Dülger
- Department of Gastroenterology, Giresun University Faculty of Medicine, Giresun, Turkey
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3
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Kumar S, Harisankar AG, Singh R, Kumar A, Kumar B, Mandal M. Lipoma of the gastrointestinal tract: a tertiary care centre experience. Ann R Coll Surg Engl 2024; 106:401-406. [PMID: 37823391 PMCID: PMC11060862 DOI: 10.1308/rcsann.2023.0063] [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] [Accepted: 08/02/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Gastrointestinal (GI) lipomas are rare; however, they are frequent enough to be considered in the differential diagnosis of gut tumours. Here, we present our experience with GI lipomas managed at our institute over the last three years. METHODS This is a retrospective cohort study of patients with GI lipomas managed between January, 2020 and April, 2023 at a tertiary care centre. Clinical presentation, location, and details of surgical procedure were analysed. RESULTS Ten patients were included, six of whom had lipoma in the colon, one in the stomach, and one each in the duodenum, jejunum, and ileum. The mean age at the time of presentation was 48.8 years (range, 19-77 years), and strong male preponderance (4:1) was noted. Preoperative diagnosis of lipoma on cross-sectional imaging was possible in all patients. All patients were symptomatic and were managed surgically. CONCLUSIONS While GI lipomas are generally considered to be indolent and benign tumours, they can potentially lead to severe complications. The utilisation of computed tomography and magnetic resonance imaging has brought about a significant transformation in diagnosing this condition, enabling preoperative identification in most cases. The surgery offers a definitive treatment with minimal risk of postoperative complications.
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Affiliation(s)
- S Kumar
- Indira Gandhi Institute of Medical Sciences, India
| | | | - R Singh
- Indira Gandhi Institute of Medical Sciences, India
| | - A Kumar
- BIG Apollo Spectra Hospitals, India
| | - B Kumar
- Sri Krishna Medical College and Hospital, India
| | - M Mandal
- Indira Gandhi Institute of Medical Sciences, India
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4
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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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5
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Pichioni P, Kokkinovasilis D, Stylianou S, Al Mogrampi S. A Colonic Lipoma Causing Obstruction: A Case Report and Review of Literature. Cureus 2023; 15:e50561. [PMID: 38111811 PMCID: PMC10726069 DOI: 10.7759/cureus.50561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 12/20/2023] Open
Abstract
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.
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Affiliation(s)
- Polyxeni Pichioni
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | | | - Stylianos Stylianou
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | - Saant Al Mogrampi
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
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Eberspacher C, Arcieri S, Lauro A, Palma R, Coletta E, Arcieri FL, Mascagni D, Pontone S. Sizzling Fat-Curative Endoscopic Resection of a Giant Lipoma Causing Colo-Colic Intussusception. Dig Dis Sci 2023; 68:4123-4126. [PMID: 37733131 DOI: 10.1007/s10620-023-08087-w] [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: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023]
Abstract
Giant colonic lipomas, tumors that infrequently occur in the gastrointestinal tract, can manifest as bleeding, abdominal pain and, in few cases, obstruction with intussusception. Surgery is usually the treatment of choice. We report the case of a 78 years-old woman with abdominal pain, constipation, and bleeding due to a giant lipoma of the sigmoid colon causing intussusception. After an initial diagnostic colonoscopy, the patient underwent an endoscopic mucosal resection (EMR) without complications. Even if surgery is traditionally the primary therapeutic approach for giant colonic lipomas, selected cases can be successfully treated with EMR.
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Affiliation(s)
- Chiara Eberspacher
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Stefano Arcieri
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Augusto Lauro
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy.
| | - Rossella Palma
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Enrico Coletta
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Francesco Leone Arcieri
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Domenico Mascagni
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Stefano Pontone
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
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7
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Vishnu J, Kapil N, Pe V, Patnaik P. Giant Colonic Lipoma Remains a Surgeon's Domain: A Report of Two Cases. Cureus 2023; 15:e43488. [PMID: 37719513 PMCID: PMC10499540 DOI: 10.7759/cureus.43488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Colonic lipomas are rare benign submucosal tumors that are mostly asymptomatic. With increasing size, they may develop symptoms and complications. The acute presentation may be intestinal obstruction secondary to intussusception or gastrointestinal bleeding. The chronic presentation may be subtle and mimic a colonic malignancy. Symptoms include altered bowel habits, abdominal pain, lower gastrointestinal bleeding, and weight loss. Diagnostic evaluation includes advanced imaging such as Computed Tomography, Magnetic Resonance Imaging, and Endoscopy. With the advent of endoscopic submucosal dissection techniques, the therapeutic capabilities of endoscopy have expanded over the decade. However, surgical interventions were reserved for large, symptomatic lipomas, and resection varies from segmental colonic resection to hemicolectomy. Size and clinical presentation determine the therapeutic approach. We, with this, report two cases of giant colonic lipoma in the right colon causing a colo-colic intussusception.
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Affiliation(s)
- Jaai Vishnu
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Nagaraj Kapil
- Surgical Gastroenterology, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Vaishnavi Pe
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Pooja Patnaik
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
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Haider S, Peller M, Lamm V, Bazarbashi AN. Loop-and-let-go technique for the management of symptomatic large colonic lipoma. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:325-327. [PMID: 37575145 PMCID: PMC10422078 DOI: 10.1016/j.vgie.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1We depict (1) identification of a large lipoma in the sigmoid colon; (2) radial echo endoscopy confirming diagnosis; (3) removal with the loop-and-let-go technique; (4) ex vivo demonstration of the technique; and (5) an interval follow-up demonstrating healing of the lesion.
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Affiliation(s)
- Syedreza Haider
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Peller
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Vladimir Lamm
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
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9
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Aassouani F, Bassim Alami G, Charifi Y, Assofi H, Attar A, El Bouardi N, Abid H, Haloua M, Ibnmajdoub K, Lamrani MYA, Boubbou M, Maaroufi M, Alami B. Sigmoid lipoma as an exceptional cause of intussusception and bowel obstruction in adults: A case report and review of literature. Radiol Case Rep 2022; 17:3955-3958. [PMID: 36032208 PMCID: PMC9399410 DOI: 10.1016/j.radcr.2022.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Acute intestinal intussusception in adults is a rare condition, most often secondary to an organic lesion (tumor or inflammation), representing 1%-5% of intestinal obstructions. Pure colic intussusception on lipoma rectal causing bowel obstruction is an exceptional situation. A 60-year-old man presented to the emergency department for acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. Colonic lipomas of the recto-sigmoid region represent a very rare condition and a subsequent etiology for intussusception and bowel obstruction in adults. However, it should be considered in the differential diagnosis of such situations.
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10
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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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11
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Huang C, Steinhauser C, Bush A, Laczek J. Loop-and-Let-Go: Treatment of a Large Colonic Lipoma After Unsuccessful Unroofing. ACG Case Rep J 2022; 9:e00848. [PMID: 36061250 PMCID: PMC9433057 DOI: 10.14309/crj.0000000000000848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/14/2022] [Indexed: 01/01/2024] Open
Abstract
Gastrointestinal lipomas are benign subepithelial tumors arising from adipose tissue. Most colonic lipomas are clinically silent and do not require intervention. However, if the lipomas are large or symptomatic, removal can be considered. Of the endoscopic techniques available, endoscopic ligation, also known as "loop-and-let-go," provides a safe and easy alternative to other endoscopic therapies and does not require any specialized equipment or advanced training. We describe a case of a patient found to have large colonic lipoma that recurred after endoscopic unroofing but was successfully treated with "loop-and-let-go."
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Affiliation(s)
- Cherry Huang
- Department of Medicine, Division of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Christina Steinhauser
- Department of Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Allison Bush
- Department of Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jeffrey Laczek
- Department of Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD
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12
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Colonic lipomas revisited on CT colonography. Abdom Radiol (NY) 2022; 47:1788-1797. [PMID: 35303113 DOI: 10.1007/s00261-022-03489-2] [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: 01/01/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE CT colonography (CTC) is growing in its utilization as a nationally approved colorectal cancer screening test. After colonic polyps, lipomas are the second most common colonic lesions and their accurate and rapid recognition are important. METHODS This retrospective Institutional Review Board approved study was performed at two large academic university-based institutions. 1044 patients underwent CTC at Institution A from 2010 to 2018 and 1094 patients underwent CTC at Institution B from 2003 to 2015. All CTC examinations with at least one colonic lipoma in their report were evaluated by a fellowship-trained abdominal imaging radiologist. 47 CTC examinations containing 59 colonic lipomas were detected and included. Segmental location, sessile versus pedunculated morphology, multiplicity, average attenuation, and largest lesion diameter were evaluated. A review of the current literature on colonic lipomas is entailed. RESULTS The overall incidence of colonic lipoma was 2.2% in women and 2.3% in men. Mean age for detection of colonic lipomas on CTC was 66.9 years. Segmental locations of colonic lipomas include ascending colon (39%), transverse colon (19%), ileocecal valve (12%), cecum (12%), descending colon (10%), and rectosigmoid (8%). 9% of colonic lipomas were multiple, 42% were pedunculated, and 58% were sessile. The mean (range) size of detected lipomas was 19 (6-59) mm. The mean (range) attenuation was - 132 (- 41 to - 258) HU. CONCLUSION Most colonic lipomas are located in the ascending colon. Although they are typically solitary, just under 10% are multiple, and although they are most often sessile, slightly under half are pedunculated mimicking polyps. CTC detects smaller lipomas than optical colonoscopy.
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13
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Prien C, Riaz A, Sutton E, Sherwinter D, Rhee RJ. Management Options of Giant Colonic Lipomas. Cureus 2022; 14:e23370. [PMID: 35475073 PMCID: PMC9020807 DOI: 10.7759/cureus.23370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Colonic lipomas are rare, benign neoplasms, typically asymptomatic, and predominantly found incidentally during autopsy or routine surveillance. Symptomatic lesions are usually those greater than 2 cm in diameter while “giant” lesions are characterized as those over 4 cm. Presentations can vary from asymptomatic to more severe sequelae, including obstruction, gastrointestinal bleeding, or intussusception. Resection of these lesions has historically been restricted to large or symptomatic lesions. However, recent reports suggest lipomas may retain the ability to grow and can become symptomatic over time despite being inconsequential initially. This series provides a review of the clinical manifestations of colonic lipomas, radiographic characteristics, and a treatment recommendation for management of these lesions using minimally invasive surgical techniques whilst advocating for consideration of resection prior to the development of symptoms or more emergent complications.
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14
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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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15
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Ko YL, Matsuoka H, Nomaru R, Imakiire S, Sakisaka H, Matsuoka S, Kuno N, Abe K, Funakoshi S, Ishida Y, Ishibashi H, Koga K, Saito T, Takeshita M, Hirai F. Observation of the drainage process of the residual lipoma after endoscopic unroofing technique during colonoscopic evaluation of post-procedural hematochezia. Clin J Gastroenterol 2022; 15:407-412. [PMID: 35076862 DOI: 10.1007/s12328-022-01594-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
A 57-year-old man was referred to our hospital for further management of a subepithelial lesion noted on colonoscopy. He underwent endoscopic treatment of unroofing technique, in which the protruding portion of the tumor was partially resected. Due to a small amount of hematochezia, colonoscopy was performed to re-evaluate the lesion post-treatment. This enabled the observation of the drainage process of the residual lipoma. Remission was achieved and confirmed 8 months after the treatment. Endoscopic unroofing technique has been reported as a safe and effective method of treating lipomas, particularly large ones. To the best of our knowledge, this is the first endoscopic unroofing case in which the drainage process of the residual lipoma was observed and the remission of the lesion was confirmed.
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Affiliation(s)
- Yi-Ling Ko
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hiroki Matsuoka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Ryohei Nomaru
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - So Imakiire
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hideto Sakisaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Satoshi Matsuoka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Nobuaki Kuno
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Koichi Abe
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hideki Ishibashi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Kaori Koga
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Tetsuhiro Saito
- Ai Clinic of Internal Medicine and Gastroenterology, 1 Chome-6-24 Komodanishi, Iizuka, Fukuoka, 820-0017, Japan
| | - Morishige Takeshita
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan.
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16
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Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review. J Clin Med 2021; 10:jcm10215149. [PMID: 34768668 PMCID: PMC8584916 DOI: 10.3390/jcm10215149] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Results: Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm3. Conclusions: A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization.
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17
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Affiliation(s)
- Livia Archibugi
- PancreatoBiliary Endoscopy and Endosonography DivisionPancreas Translational and Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
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18
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Yamamoto K, Ikeya T, Shiratori Y. Endoscopic unroofing and mucosal resection for a large colonic lipoma with intussusception: an effective hybrid technique. VideoGIE 2021; 6:190-192. [PMID: 33898900 PMCID: PMC8058103 DOI: 10.1016/j.vgie.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Kazuki Yamamoto
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
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19
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Zippi M, Toma A, Paoluzi N, Maccioni F, Pica R. An Ulcerated Large Colic Lipoma Causing Rectorrhagia Treated With Endoscopic Loop-Assisted Resection. Cureus 2021; 13:e14321. [PMID: 33968531 PMCID: PMC8101558 DOI: 10.7759/cureus.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Colonic lipomatous polyps are often an incidental finding during colonoscopy. Generally, these types of polyps can cause gastrointestinal bleeding when they are larger than 4 cm in size. Some case reports have documented the occurrence of overlying adenomatous formations in the apical portion, as well as ulcerated mucosa. There is currently no standardized endoscopic removal technique for their treatment. In this report, we present a case of a large and ulcerated lipoma causing rectorrhagia, which was successfully treated with endoscopic en-bloc resection and endoloop placement.
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Affiliation(s)
- Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Antonella Toma
- Unit of Urgent Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Nada Paoluzi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
| | - Francesca Maccioni
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Policlinico Umberto I, Rome, ITA
| | - Roberta Pica
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, ITA
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20
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Liyen Cartelle A, Uy PP, Yap JEL. Giant Colonic Lipoma Presenting as Intermittent Colonic Obstruction With Hematochezia. Cureus 2020; 12:e11434. [PMID: 33324517 PMCID: PMC7732735 DOI: 10.7759/cureus.11434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Colonic lipomas are rare benign, non-epithelial tumors of mesenchymal origin. They are often solitary lesions of submucosal origin found in the proximal colon and typically measure less than 2 cm in size. Giant colonic lipomas are greater than 4 cm and present with non-specific gastrointestinal symptoms such as abdominal pain, abdominal distention, constipation, or gastrointestinal bleeding. Traditionally, giant colonic lipomas have been surgically rather than endoscopically resected due to concerns for bowel wall perforation and life-threatening hemorrhage. However, in recent years, advances in endoscopic tools and hemostatic techniques have lessened these risks. The following case details the successful endoscopic resection of an intermittently obstructing giant colonic lipoma (6 cm) located in the descending colon utilizing the loop-assisted-snare resection technique.
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Affiliation(s)
- Anabel Liyen Cartelle
- Division of Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - Pearl Princess Uy
- Division of Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - John Erikson L Yap
- Division of Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
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21
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Law YY, Patel R, Cusick M, Van Eps JL. A case of colonic intussusception and obstruction secondary to giant colonic lipoma. J Surg Case Rep 2020; 2020:rjaa429. [PMID: 33154813 PMCID: PMC7602363 DOI: 10.1093/jscr/rjaa429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 01/05/2023] Open
Abstract
Lipomas are benign soft tissue tumors found throughout the body including the gastrointestinal (GI) tract. Colonic lipomas are typically asymptomatic, incidentally identified during endoscopy or at the time of autopsy. However, giant lipomas larger than 4 cm usually manifest symptoms such as abdominal pain, obstruction, melena or intussusception. The transverse colon is the least common location for colonic lipoma. We report on a 54-year-old man with acute large bowel obstruction secondary to a long segment colo-colonic intussusception from a giant lipoma originating in the transverse colon. The diagnosis was suggested by advanced imaging and confirmed on endoscopy. He was treated successfully by laparoscopic extended right hemicolectomy with ileocolonic anastomosis. This case highlights the complexity of presentation and surgical management of large bowel obstruction and colonic intussusception, as well as the rare entity of giant colonic lipoma.
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Affiliation(s)
- Yi Ying Law
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Rhea Patel
- Department of Surgery, Section of Colon & Rectal Surgery, McGovern Medical School, UT Health Science Center at Houston, Houston, TX, USA
| | - Marianne Cusick
- Department of Surgery, Section of Colon & Rectal Surgery, McGovern Medical School, UT Health Science Center at Houston, Houston, TX, USA.,UT Physicians Colon and Rectal Clinic, Houston, TX, USA
| | - Jeffrey L Van Eps
- Department of Surgery, Section of Colon & Rectal Surgery, McGovern Medical School, UT Health Science Center at Houston, Houston, TX, USA.,UT Physicians Colon and Rectal Clinic, Houston, TX, USA
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