RESUMO: O lipoma colorretal é incomum. A maior parte das lesões são únicas, localizadas na submucosa, assintomáticas, sendo descoberta em autópsias ou em laparatomia por outras condições. Porém, em alguns casos são sintomáticos, e podem causar sangramento, obstrução intestinal, cólicas intestinais, prolapso e intussuscepção. Apresentamos um caso de lipoma submucoso de cólon transverso, cuja apresentação foi de intussuscepção intermitente. O lipoma foi ressecado através de uma colectomia segmentar e o paciente teve alta em bom estado geral. Descritores RELATO DO CASOO. S., prontuário 96028, masculino, 37 anos, branco, natural e procedente de Santo Antônio da Platina (PR), agricultor, internado com dor abdominal tipo cólica, em quadrante superior esquerdo do abdômen e flanco esquerdo, náusea, vômitos. A dor era intermitente. Suspeitou-se de cólica nefroureteral, porém ultrasonografia e exame parcial de urina foram normais. Paciente persistiu com sintomas, intermitentes e foi então solicitada uma colonoscopia que mostrou colite em sigmóide e lesão pediculada , com base larga, no colon transverso, recoberta com material fecal, retrá-til, ocupando aproximadamente 70% da luz colônica (Figura 1). Tentativas de excisão foram infrutíferas e foram realizadas biópsias do pedículo da lesão. Na Laparotomia, encontramos colon tranverso com peristatismo intenso e com intussuscepção. Realizamos ordenha retrógrada e o colon voltou a sua posição original. Palpamos massa tumoral amolecida e decidimos realizar colotomia sobre a massa. Encontramos tumor com superfície homogênea, recoberta por fezes, com pedículo muito largo. Decidimos pela facilidade anatômica realizar uma colectomia transversa segmentar, com anastomose primária em dois planos, com acido poliglicólico. O resultado anatomopatológico foi de massa de 7/4/3cm , superfície levemente lobulada, granulosa, creme acastanhada, compatível com lipoma submucoso (Figura 2). Paciente evoluiu bem no pós-operatório, com fístula de baixo débito, que fechou rapidamente tendo o paciente alta no 9º dia.

BACKGROUND Endometriosis is a common disease in reproductive-age women and it is estimated to occur in up to 50% of those with infertility. Intestinal involvement is reported in up to a third of the cases. This condition is related to chronic pain and loss of quality of life, resulting in emotional, social and economic costs. Treatment consists of hormonal block and surgical resection, with variable side effects and efficacy. The best choice for surgical treatment for rectal endometriosis is a matter of discussion regarding the indication and the best technique to be employed. OBJECTIVE To summarize data on indications, results and complications of surgical techniques for the treatment of rectal endometriosis. METHODS: This comprehensive systematic review is a compilation of the available literature and discussion, carried out by a team with experience in the surgical treatment of intestinal endometriosis. Data regarding indications, results and complications of conservative and radical techniques for the surgical treatment of rectal endometriosis was carefully reviewed. Searches of PubMed, EMBASE, and CENTRAL up to May 2021 were performed to identify randomized controlled trials (RCTs) and observational studies that compared at least two of the three surgical techniques of interest (i.e., shaving, discoid resection, segmental resection). RESULTS: One RCT and nine case series studies with a total of 3,327 patients met the eligibility criteria. Participants ages ranged from a mean of 30.0 to 37.9 years old. Mean follow-up ranged from 1.2 to 42.76 months. With regards the methodological quality, overall the included studies presented a low risk of bias in the majority of the domains. Surgical treatment of rectal endometriosis is indicated for patients with obstructive symptoms and those with pain scores above 7/10. Patients with disease involving beyond muscularis propria of the rectum, documented in magnetic resonance imaging or transvaginal pelvic ultrasound with intestinal preparation, are candidates for discoid or segmental resection. The presence of multifocal disease, extension greater than 3 cm and infiltration greater than 50% of the loop circumference favor the radical technique. The distance from the lesion to the anal verge, age, symptoms and reproductive desire are other factors that influence the choice of the technique to be employed. The risk of complications and unfavorable functional results seems to be directly related to the complexity of the procedure. CONCLUSION: The choice of surgical technique performed for the treatment of rectal endometriosis is a matter of discussion and depends not only on the preoperative staging, but also on the patient’s expectations, risks and potential complications, recurrence rates and the expertise of the multidisciplinary team.

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Diverticular disease is the most common morphological abnormality of the colon. It is increasing in prevalence proportionally to progressive aging and modern alimentary diet. The majority of the diverticular disease affects the sigmoid colon and the segmental inflammatory process can have different outcomes, from self-limited, low-grade inflammation to severe cases evolving to complications such as abscess, fistulas to different organs, free perforation and peritonitis, sepsis, intestinal obstruction, and hemorrhage. In this chapter, we will focus on a few of these complications—focal low-grade inflammation, intra-abdominal abscess, and fistulas.