Pedunculated colonic lipoma prolapsing through the anus

Abstract

Colorectal lipomas are the second most common benign tumors of the colon. These masses are typically incidental findings with over 94% being asymptomatic. Symptoms-classically abdominal pain, bleeding per rectum and alterations in bowel habits-may arise when lipomas become larger than 2 cm in size. Colonic lipomas are most often noted incidentally by colonoscopy. They may also be identified by abdominal imaging such as computed tomography or magnetic resonance imaging. We report a case of a sixty-one years old male who presented to our emergency room with a 6.7 cm × 6.3 cm soft tissue mucosal mass protruding transanally. The patient was stable with a benign abdominal examination. The mass was initially thought to be a rectal prolapse; however, a limited digital rectal exam was able to identify this as distinct from the anal canal. Since the mass was irreducible, it was elected to be resected under anesthesia. At surgery, manipulation of the mass identified that the lesion was pedunculated with a long and thickened stalk. A laparoscopic linear cutting stapler was used to resect the mass at its stalk. Pathology showed a polypoid submucosal lipoma of the colon with overlying ulceration and necrosis. We report this case to highlight this rare but possible presentation of colonic lipomas; an incarcerated, trans-anal mass with features suggesting rectal prolapse. Trans-anal resection is simple and effective treatment.

Spontaneous Expulsion per Rectum of a Colorectal Polyp: A Rare and Unusual Case

“…The spontaneous expulsion per rectum of a polyp is rare, and the literature regarding such cases is limited. There have been several reported cases of rectal expulsion of lipomas [ 22 - 29 ]. With an incidence of 0.035-4.4%, lipomas are the second-most common benign tumors of the colon [ 22 ].…”

A Massive Colorectal Lipoma Prolapsed with Invagination Through Anal Canal: Case Report

“…4 Lipomas located at colon are generally asymptomatic and diagnosis is generally made by endoscopic procedures or incidentally during abdominal surgeries. 5 Size of lipomas may range between 2 mm and 30 cm in diameter. 6 Symptoms are correlated with size of lipoma.…”

“…2 Regular follow-ups are suggested for asymptomatic lipomas incidentally detected which was sized below 2 cm whereas endoscopic excision is suggested for symptomatic lipomas. 2,5 Risk of perforation and bleeding during endoscopic excision is increased in lipomas sized above 2 cm in diameter. Therefore, segmental colectomy is preferable among other surgical methods.…”

“…Therefore, segmental colectomy is preferable among other surgical methods. 5 Transanal excision may be performed in distally localized masses. However; a case report related with excision of a 7 cmsized colon lipoma after endoscopic submucosal dissection without complication is present in literature.…”

Lipomas – a health condition that cannot be ignored

“…lipomas measuring in diameter more than 4 cm are considered large and may cause symptoms such as: pain, diarrhea, constipation, vomiting, nausea, obstruction, intussusception and bleeding [8,16,17]. Pedunculated lipomas located in the distal section of the gastrointestinal tract may also present symptoms similar to rectal prolapse [18]. in contrast to all other lipomas, lesions located in the colon are more common in women in their 6th and 7th decade of life [19,20].…”