Giant Submucosal Lipomatous Polyp Causing Perforation of Sigmoid Colon: A Case Report and Review of Literature

Abstract

An 82-year-old man presented to the Emergency department of our hospital with chief complaints of severe lower abdomen pain, and fever since morning. He gave history of frequent bloating sensation of abdomen associated with constipation. The pain was sudden in onset following straining while defecating in the morning of the same day. On examination there was no icterus or pallor. Patient was very dehydrated, tachypnoeic with tachycardia. The abdomen was distended with diffuse abdominal guarding. Bowel sounds were absent. Patient was admitted and investigated with a provisional diagnosis of Hollow viscus perforation. Blood examination revealed counts to be elevated and chest X-ray showed gas under the diaphragm. After resuscitating the patient and correcting the metabolic derangements he was taken for exploratory laparotomy.On opening the peritoneum, faecal peritonitis was evident. A thorough peritoneal wash was given and site of perforation was looked for. The small bowel was sequentially traced for a breach in the wall starting from the terminal ileum, but there was no breach in the wall. The large bowel was traced from ceacum distally. The sigmoid colon just proximal to recto sigmoid junction revealed the site of perforation of about 4cm transversely [Table/ Fig-1]. Through the perforation a pedunculated smooth surfaced growth of about 5x6cm was protruding out through the tear in the sigmoid colon. The proximal colon was not dilated or thinned out as one would expect in chronic cases of obstruction. The rest of colon and liver was palpated for synchronous lesions/Secondaries and found to be absent. A limited resection of the sigmoid colon with primary resection anastomosis with transverse colon diversion colostomy was performed. The specimen was sent for HPR which was suggestive of an Intestinal submucosal lipomatous polyp [Table/ Fig-2]. 10x view section shows normal mucosa with underlying adipocytes(arrow) within submucosa and muscular layer & [Table / Fig-3] 40x view of the lipocytes.The patient postoperatively developed septicaemia and needed prolonged ICU care. He was discharged on the 18 th Post operative day. ABSTRACTColonic lipomas are rare benign tumours that are usually asymptomatic. Large colonic lipomas can present with symptoms such as constipation, abdominal pain, bleeding per rectum, and intussusception. We report the case of an 82-year-old man presenting with sudden onset lower abdomen pain and features of peritonitis. An exploratory laparotomy revealed a perforation of sigmoid colon with a fleshy mass protruding through the perforation. No case of spontaneous perforated sigmoid colon by submucous giant lipoma is reported yet in the literature. We discuss the details of first such case, our management, the outcome and also briefly review the literature.

Large colonic lipoma with a laterally spreading tumor treated by endoscopic submucosal dissection: A case report

“…Colonic lipoma is mostly asymptomatic, but can sometimes be associated with complications. Reported complications included hemorrhage[ 6 ], obstruction[ 7 ], perforation[ 8 ], and intussusception[ 9 ]. All of these complications are caused by secondary colon damage to mechanical injury of the colonic lipoma.…”

Lipoma de recto prolapsado e incarcerado: caso clínico y análisis de la literatura

“…3,10 Cuando son pediculados, su torsión intermitente con isquemia pueden dar lugar a una masa ulcerada, irregular e hipercromática, otorgándole una apariencia pseudomaligna en la colonoscopia, por lo que pueden confundirse con pólipos adenomatosos o tumores agresivos. 11 Los lipomas de recto de gran tamaño pueden presentarse con síntomas indistinguibles a los del cáncer rectal, como pujos, tenesmos, rectorragia y menos frecuentemente, prolapso. El paciente manifiesta la protrusión de una tumoración a través del ano durante el acto defecatorio, que posteriormente puede reintroducirse espontánea o activamente.…”

Ileo-colic intussusception by ileo-cecal valve lipoma – an infrequent ultrasonographic occurrence. A case report.

“…US is a readily available and a more generalized technique than CT, enabling it to be used more often with emergency and acute symptoms and thus being available at times of abdominal crisis in intermittent processes [14,15].US allows a study on all planes and in real time, which is important as intussusception is often a dynamic phenomenon [16].…”