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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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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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João M, Cunha I, Gravito-Soares E, Gravito-Soares M, Amaro P, Figueiredo P. An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2022; 29:45-50. [PMID: 35111963 PMCID: PMC8787603 DOI: 10.1159/000513967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/06/2020] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required. CASE REPORT A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic. DISCUSSION/CONCLUSION Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.
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Affiliation(s)
- Mafalda João
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Inês Cunha
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University of Coimbra, Faculty of Medicine, Coimbra, Portugal
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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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Teramoto A, Hamada S, Utsumi T, Hirata D, Sano Y. Successful endoscopic management of adult ileocecal intussusception secondary to a large ileal lipoma. VideoGIE 2021; 6:187-189. [PMID: 33898899 PMCID: PMC8058388 DOI: 10.1016/j.vgie.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Seiji Hamada
- Gastrointestinal Center, Urasoe General Hospital, Urasoe, Japan
| | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Kobe, 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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Valdivielso Cortázar E, López Álvarez M, Guerrero Montañes A, Yañez González-Dopeso L, Yañez López JÁ, Alonso Aguirre PA. Ileocolic intussusception of ileal lipoma as a cause of lower gastrointestinal bleeding. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:457-458. [PMID: 27496808 DOI: 10.1016/j.gastrohep.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - María López Álvarez
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | | | | | - Jesus Ángel Yañez López
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
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