Endoscopic Resection of a Large Colonic Lipoma: Case Report and Review of Literature

Abstract

Colonic lipomas are uncommon, benign, submucosal adipose tumors that are usually asymptomatic. Large lipomas can cause symptoms such as constipation, abdominal pain, rectal bleeding and intussusception. We report the case of a 60-year-old man with a history of lower abdominal pain and pseudoobstructive symptoms. Colonoscopy revealed a large polypoid sessile lesion in the sigma. We used a standardized technique of polypectomy, preceded by submucosal injection of dilute 5 ml polygelin with epinephrine 1:10,000 solution, to fully resect large colonic lipomas. The lipoma size was 3.5 cm. No bleeding or perforation developed. Histology showed the polyp to be a submucosul lipoma. On follow-up, there was no residual lesion. Colonic lipomas larger than 2 cm can be safely and efficaciously removed using electrosurgical snare polypectomy technique. The technique of submucosal injection before resection and using an electrocautery snare appears to be safe and reduces the risk of perforation reported in the literature.

Colonic intussusception caused by an ulcerating lipoma in an adult: A rare case report and literature review

“…Colonic lipomas are benign submucosal tumors composed of mature adipose tissue and were first reported by Bauer in 1757 [2,3]. After reviewing the literature for the most recent cases (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13], we concluded that most lipomas range in size from 2 mm to 30 cm and that the majority of patients are between 50 and 70 y of age, with a female predominance. Colonic lipomas are typically asymptomatic or minimally symptomatic when less than 2.0 cm in size, and they are usually detected during endoscopy, surgery, or autopsy.…”

“…During colonoscopy, colonic lipomas typically appear as a submucosal mass covered by intact mucosa. Elevation of mucosa using biopsy forceps ("tent sign"), indentation of mucosa after pressing on it ("cushion sign"), or extrusion of fat after biopsy ("naked fat sign") are also observed [10][11][12]. Lipomas can be difficult to differentiate from a malignant lesion due to the associated necrotic mucosa, ulceration, and relatively hard texture of the lesion.…”

“…Various endoscopic procedures including snare resection, ESD, and unroofing or the endoloop technique have been introduced recently for safe resection. Khorashad et al and Geraci et al suggest that endoscopic removal of colonic lipomas larger than 2 cm, even if is technically difficult because of their vascular nature, large pedicle, and size, is safe, feasible and effective using standard polypectomy technique with the availability of endoloop and hemoclips in case of uneventful complications or to prevent it [10,12].…”

Prolapse of Submucous Lipoma of the Sigmoid Colon

“…Yet surgery is only recommended if the lipoma is more than 20 mm in size as smaller lipomas often remain asymptomatic and the risk of invagination therefore is insignificant (1, 2, 7, 13). Some authors, however, have reported that these can be treated endoscopically (14). In these cases it should be considered thoroughly as the risk of perforation is large (9,15).…”

Large Pedunculated Lipoma of the Colon: Endoscopic Resection Using “Loop-and-Let-Go” Technique

“…The patient became asymptomatic with an uneventful course. Follow-up colonoscopy at 2 months was normal.Gastrointestinal lipomas are rare subepithelial benign tumors, being more common in the colon [1][2][3][4]. Diagnosis is usually easy because of typical endoscopic features.…”