Gastrointestinal: A sigmoid lipoma as the cause of intussusceptionA 64 year-old female with a past medical history of hypertension and hypothyroidism presented to general medicine clinic with 1 month of intermittent left lower quadrant abdominal pain and 1 day of hematochezia. About 3 months prior to presentation, she underwent screening colonoscopy at an outside hospital, which identified a 5 cm submucosal lipoma. The day of presentation, she reported five episodes of hematochezia with bright red blood and clots. She was sent to the emergency room for further evaluation where a CT scan of her abdomen and pelvis identified an intussusception immediately proximal to the lipoma (Fig.1).Lipomas are the second most common benign colon neoplasms after adenomatous polyps and account for about 4% of all benign tumors in the gut. Over 70% are found in the right colon. Specifically, the most common location is the cecum, followed by the ascending and then the sigmoid colon. Most colonic lipomas are asymptomatic and are found during colonoscopy or surgery for other indications. However, symptoms correlate with size of the lipoma, and lipomas larger than 4 cm in size (giant lipomas) become symptomatic in 75% of patients. The most common symptoms include abdominal pain and alteration in bowel habits. More rarely, they may presents with obstruction, perforation, or gastrointestinal bleeding. Giant lipomas are the most common benign colonic tumors leading to intussusception. When complicated by intussusception or perforation, surgical management is necessary. For patients incidentally found to have a lipoma, small lipomas (<2 cm) can generally be observed. Options for managing larger asymptomatic lipomas include both surgical and endoscopic resection (Fig. 2). Figure 1 A classic target sign (arrow) of alternating hypodense and hyperdense layers is seen at the level of the intussusception on CT scan.Figure 2 Gross pathology specimen of the resected colon including the lipoma (arrow).
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