An Ulcerated Large Colic Lipoma Causing Rectorrhagia Treated With Endoscopic Loop-Assisted Resection

Giant Ulcerated Colonic Lipoma in an Asymptomatic Patient

Colonic lipomas are benign masses typically found incidentally during routine screening exams. They rarely grow large enough to become symptomatic. While most colonic lipomas are small and do not lead to complications, giant lipomas can present with symptoms ranging from changes in bowel patterns and mild abdominal pain to bowel obstruction. Ulcerated giant colonic lipomas are even more rare findings on screening colonoscopies. Diagnosis in this context can be challenging, and resection is warranted in most cases. Here, we describe an asymptomatic patient who presented for a screening colonoscopy and was found to have a giant ulcerated colonic lipoma.

Management Options of Giant Colonic Lipomas

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.