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Fiordaliso M, Lovaglio UM, De Marco FA, Costantini R, Nasti GA, Lelli Chiesa P. Colonic lipoma, a rare cause of intestinal intussusception: A narrative review and how to diagnose it. Medicine (Baltimore) 2024; 103:e39579. [PMID: 39331924 PMCID: PMC11441952 DOI: 10.1097/md.0000000000039579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/15/2024] [Indexed: 09/29/2024] Open
Abstract
Colonic lipomas (CLs) are benign tumors of the adipose tissue of the gastrointestinal tract that are often asymptomatic. A search of medical literature in English using PubMed and Google Scholar was conducted for articles related to CL. Occasionally, patients present with intestinal bleeding or obstructive symptoms. Although intussusception is commonly observed in children, it is rare in adults. Moreover, CL as the most common entity, is very rare, with an incidence rate of 0.035% to 4.4%. Although fatty composition can assist in diagnosis through computed tomography and magnetic resonance imaging, the latter cannot exclude local infiltration. CLs are distributed evenly between both sexes and can be located anywhere in the gastrointestinal tract; however, they are more frequently located in the colon, particularly in the right colon and cecum (39.6%), followed by the transverse colon (25%), descending colon (20.8%), and the sigmoid colon (14.6%). Symptoms included abdominal pain (79.2%), alterations in bowel habits (45.8%), rectal bleeding (22.9%), colocolic intussusception (50%), weight loss (6.2%), vomiting (14.6%), and nausea (12.5%). Surgical and endoscopic techniques are widely used to manage CLs. The challenge for physicians is differentiating this lesion from malignant colonic lesions, at the outset. The risk of misdiagnosis is possible, and the recommendation in cases of doubt is still segmental surgical resection, as it ensures correct collection of lymph nodes for appropriate staging of presumed colonic carcinoma.
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Affiliation(s)
- Michele Fiordaliso
- Department of Medicine and Ageing Sciences, University “G. D’Annunzio” of Chieti-Pescara, Pescara, Italy
| | | | | | - Raffaele Costantini
- Department of Medical, Institute of Surgical Pathology, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti, Pescara, Italy
| | - Gennaro A. Nasti
- Department of General Surgery, Lagonegro-San Carlo Hospital, Potenza, Italy
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, Hospital “Santo Spirito” of Pescara and University “G. d’Annunzio” of Chieti Pescara, Pescara, Italy
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Tsai KJ, Tai YS, Hung CM, Su YC. Cecal lipoma with subclinical appendicitis: A case report. World J Clin Cases 2019; 7:209-214. [PMID: 30705897 PMCID: PMC6354092 DOI: 10.12998/wjcc.v7.i2.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/23/2018] [Accepted: 12/30/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colonic lipomas are rare, slow-growing benign tumors. Colonic lipomas are generally asymptomatic and are found incidentally. Although cases of cecal lipoma have been sporadically reported in the literature, the disease has not been systematically reviewed.
CASE SUMMARY We present a 44-year-old man who underwent a routine physical check-up during which colonoscopic examination revealed an asymptomatic 1.5-cm cecal mass at the appendiceal orifice. Laparoscopic exploration was performed that also demonstrated a congested and erythematous appendix. En bloc resection of both the cecum and vermiform appendix was performed because of the suspicion of malignancy. Histopathological examination revealed a cecal lipoma composed of mature adipose tissue, and the appendix showed subclinical inflammation. Our procedures and findings were discussed, along with relevant English literature that was retrieved from the PubMed database from 2000 to 2017. Twenty-six cases, including ours, were reported. Consistent with the findings of the literature, it is difficult to obtain a definitive diagnosis by colonoscopic biopsy.
CONCLUSION Surgery remains the treatment of choice for this condition. Intraoperative frozen pathological sectioning helped the surgeon decide the extent of surgery, and radical surgery was avoided. Excision of benign lesions occupying the appendiceal orifice may be indicated for the prevention of later development of acute appendicitis. The prognosis is generally good, with only one of the 26 reported patients complicated with acute appendicitis, who subsequently succumbed due to severe comorbidities and sepsis.
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Affiliation(s)
- Kuen-Jang Tsai
- Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
| | - Yun-Sheng Tai
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
| | - Chao-Ming Hung
- Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
| | - Yue-Chiu Su
- Department of Pathology, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
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3
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Clinicopathologic analysis and subclassification of benign lipomatous lesions of the colon. Virchows Arch 2018; 474:309-313. [DOI: 10.1007/s00428-018-2489-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/25/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022]
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Shi L, Zhao Y, Li W. Endoscopic resection of a giant colonic lipoma with endoloop-assisted unroofing technique: A case report. Medicine (Baltimore) 2018; 97:e10995. [PMID: 29879057 PMCID: PMC5999471 DOI: 10.1097/md.0000000000010995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/15/2018] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Colonic lipomas are uncommon benign submucosal adipose tumorsthat are usually asymptomatic. Large lipomas can cause symptoms require treatment in principle. We report 1 case of giant colonic lipoma removed with endoloop-assisted unroofing technique instead of conventional surgical bowel resection. PATIENT CONCERNS A 62-year-old female patient presented with intermittent abdominal discomfort for 1 month. DIAGNOSIS The patient was diagnosed as having a giant colonic lipoma. INTERVENTION Endoscopic resection with endoloop-assisted unroofing technique was performed. On the 22nd day after resection, intestinal obstruction occurred by shedding mass was found; the symptoms of this patient disappeared soon after removal of the mass by endoscopy. OUTCOMES A follow-up colonoscopy 6 months later showed a scarred mucosa at the ligation site and no residual lipoma was observed. LESSONS Endoscopic resection with endoloop-assisted unroofing technique remains a viable option for giant lipomas; however, postoperative intestinal obstruction caused by shedding mass should be noted.
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Noda H, Ogasawara N, Tamura Y, Kondo Y, Izawa S, Ebi M, Funaki Y, Sasaki M, Kasugai K. Successful Endoscopic Submucosal Dissection of a Large Terminal Ileal Lipoma. Case Rep Gastroenterol 2016; 10:506-511. [PMID: 27843426 PMCID: PMC5091281 DOI: 10.1159/000448886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 12/13/2022] Open
Abstract
A 78-year-old woman who had recurrent right lower abdominal pain for about 1 year underwent computed tomography (CT) because of a follow-up observation 1 year after right breast cancer surgery. CT revealed a tumor in the colon. The patient was referred to our hospital for detailed examinations. An abdominal CT showed a low-density tumor of approximately 30 mm in the ascending colon, and the CT density inside the tumor was same as that of fatty tissues. A subsequent colonoscopy showed a submucosal tumor (SMT) in the proximal ascending colon developing from the terminal ileum. A colonoscopic ultrasonography revealed that the SMT was a high-echoic mass mainly localized in the submucosal layer. Based on the findings from CT, colonoscopy, and colonoscopic ultrasonography, the SMT was diagnosed as a pedunculated lipoma originating from the terminal ileum and treated with endoscopic submucosal dissection (ESD) because of recurrent abdominal pain. The 40-mm tumor was resected en bloc without complications. ESD may be more appropriate than polypectomy and surgery for removal of small intestinal tumors, because ESD allows direct visualization of the cutting line and exactly dissects the submucosal layers without damaging the muscular layers. ESD is a potentially useful treatment to remove intestinal lipomas.
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Affiliation(s)
- Hisatsugu Noda
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yasuhiro Tamura
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshihiro Kondo
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shinya Izawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
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Yatagai N, Ueyama H, Shibuya T, Haga K, Takahashi M, Nomura O, Sakamoto N, Osada T, Yao T, Watanabe S. Obscure gastrointestinal bleeding caused by small intestinal lipoma: a case report. J Med Case Rep 2016; 10:226. [PMID: 27520963 PMCID: PMC4983028 DOI: 10.1186/s13256-016-1014-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/24/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Small intestinal lipomas are rare, usually asymptomatic, and most commonly encountered incidentally during investigation of the gastrointestinal tract for another reason. However, they may cause obscure gastrointestinal bleeding. CASE PRESENTATION We report a case of obscure gastrointestinal bleeding due to a small intestinal lipoma. A 69-year-old Japanese man on antiplatelet therapy presented to our department with tarry stools and anemic symptoms. A small intestinal tumor was detected by capsule endoscopy and double-balloon endoscopy. After laparoscopic resection, the tumor was confirmed to be a lipoma. CONCLUSIONS Small intestinal lipomas are difficult to detect by conventional modalities, but capsule endoscopy and double-balloon endoscopy are good modalities for the diagnosis of small intestinal lipomas. Treatment of small intestinal lipomas should be selected carefully, considering the tumor size, size of stalk, administration of antithrombotic therapy, and endoscopic operability.
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Affiliation(s)
- Noboru Yatagai
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Masahito Takahashi
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Taro Osada
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Kopáčová M, Rejchrt S, Bureš J. Unroofing Technique as an Option for the Endoscopic Treatment of Giant Gastrointestinal Lipomas. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 58:115-8. [PMID: 26960822 DOI: 10.14712/18059694.2016.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gastrointestinal lipomas are usually asymptomatic, detected incidentally. However, they can cause severe symptoms such as obstruction, invagination, and bleeding. The transsection of an infarcted or large lipoma by needle sphincterotome (needle knife) and/or snare polypectomy of the upper part of the tumour is an option for the endoscopy treatment of giant infarcted lipomas. Cutting a top of lipoma (unroofing technique) allowed flow out of adipose tissue from the lipoma.
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Affiliation(s)
- Marcela Kopáčová
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic.
| | - Stanislav Rejchrt
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
| | - Jan Bureš
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
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ZHOU XIAOCONG, HU KEQIONG, JIANG YI. A 4-cm lipoma of the transverse colon causing colonic intussusception: A case report and literature review. Oncol Lett 2014; 8:1090-1092. [PMID: 25120663 PMCID: PMC4114622 DOI: 10.3892/ol.2014.2278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 06/12/2014] [Indexed: 12/24/2022] Open
Abstract
Colonic lipomas are rare benign tumors. Colonic intussusception is an uncommon complication of colonic lipoma. The current study presents an unusual case of a 4-cm symptomatic lipoma of the transverse colon causing colonic intussusception. A 65-year-old female was admitted to Wenzhou Central Hospital (Wenzhou, Zhejiang, China) with intermittent pain in the left abdomen that had been present for two weeks. Colonoscopy revealed a 4×5-cm intraluminal spherical mass with erosional mucosa 60 cm above the anal verge, indicating the presence of a malignant gastrointestinal stromal tumor. Contrast-enhanced computed tomography revealed a well-defined fatty tissue mass of 4 cm in diameter in the distal transverse colon proximal to the splenic flexure, with intussusception. The patient underwent segmental resection of the transverse colon and intraoperative frozen sections were obtained. The intraoperative frozen sections revealed a submucosal lipoma of the transverse colon and thus, a conclusive diagnosis was achieved. The patient was followed up for one year and 10 months following the segmental resection of the transverse colon, with a good prognosis. This study may increase clinical awareness with regard to colonic lipomas. Furthermore, open surgery combined with use of intraoperative frozen sections should be recommended for large symptomatic colonic lipomas accompanied by colonic intussusception, thus avoiding unnecessary radical resection and improving patient prognosis.
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Affiliation(s)
- XIAO-CONG ZHOU
- Department of Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang 325000, P.R. China
| | - KE-QIONG HU
- Department of Clinical Pharmacy, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang 325000, P.R. China
| | - YI JIANG
- Department of Pathology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang 325000, P.R. China
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9
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Lee KJ, Kim GH, Park DY, Shin NR, Lee BE, Ryu DY, Kim DU, Song GA. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 2014; 28:185-192. [PMID: 23996333 DOI: 10.1007/s00464-013-3151-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/22/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign, slow-growing subepithelial tumors. Most lipomas are detected incidentally at endoscopy, but they can cause GI bleeding, abdominal pain, intestinal obstruction, and intussusception, particularly if they are larger than 2 cm in diameter. The aim of this study was to investigate the efficacy, safety, and long-term prognosis of endoscopic treatment of GI lipomas. METHODS A total of 28 GI lipomas treated endoscopically from January 2005 to June 2012 were retrospectively reviewed. Endoscopic treatment was performed by four methods: the unroofing technique, endoscopic mucosal resection (EMR), EMR after precutting (EMR-P), and endoscopic submucosal dissection (ESD). RESULTS Of 28 GI lipomas, 5 were located in the stomach, 2 in the duodenum, and 21 in the colon. Thirteen lipomas were <2 cm in diameter (small lipoma), and the other 15 were ≥2 cm (large lipoma). The unroofing technique was performed in 2 cases, EMR in 17 cases, EMR-P in 4 cases, and ESD in 5 cases. En bloc resection was performed with 21 lesions (75 %), and endoscopic complete resection was achieved with 26 lesions (93 %). Incomplete resection occurred in the 2 cases treated by the unroofing technique. On pathologic examination, complete resection was achieved with 21 lesions (75 %). Delayed bleeding was observed in one patient. There were no serious complications such as perforation or post-procedural stricture. During the mean follow-up period of 19 months (range 2-91 months), no recurrence was observed. CONCLUSIONS Endoscopic treatment appears to be a safe and effective treatment for GI lipomas, including large lipomas (≥2 cm in diameter).
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Affiliation(s)
- Kwang Jae Lee
- Department of Internal Medicine, Pusan National University School of Medicine, 1-10, Ami-dong, Seo-gu, Pusan, 602-739, Korea
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10
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Kim GW, Kwon CI, Song SH, Jin SM, Kim KH, Moon JH, Hong SP, Park PW. Endoscopic resection of giant colonic lipoma: case series with partial resection. Clin Endosc 2013; 46:586-90. [PMID: 24143327 PMCID: PMC3797950 DOI: 10.5946/ce.2013.46.5.586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/06/2012] [Accepted: 10/11/2012] [Indexed: 12/15/2022] Open
Abstract
Colonic lipoma, a very rare form of benign tumor, is typically detected incidentally in asymptomatic patients. The size of lipoma is reported variously from 2 mm to 30 cm, with higher likelihood of symptoms as the size is bigger. Cases with symptom or bigger lesion are surgically resected in principle; endoscopic resection, which has developed recently with groundbreaking advance of endoscopic excision technology, is being used more often but with rare report of success due to high chance of complications such as bowel perforation or bleeding. The authors report here, together with a literature review, our experiences of three cases of giant colonic lipomas showing complete remission after aggressive unroofing technique, at certain intervals, using snare catheter at the origin of the lipoma so that the remaining lipoma could be drained out of the exposed surface spontaneously, in order to reduce complications.
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Affiliation(s)
- Gun Woo Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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11
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Böler DE, Baca B, Uras C. Laparoscopic resection of colonic lipomas: When and why? AMERICAN JOURNAL OF CASE REPORTS 2013; 14:270-5. [PMID: 23901354 PMCID: PMC3726236 DOI: 10.12659/ajcr.889247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/06/2013] [Indexed: 01/04/2023]
Abstract
PATIENT Male, >60 FINAL DIAGNOSIS: Colonic lipoma Symptoms: Rectal bleeding • abdominal pain • fatique • abdominal distention MEDICATION - Clinical Procedure: Laparoscopic resection Specialty: General surgery. OBJECTIVE We aimed to review and discuss the clinical picture and management of 4 patients who underwent laparoscopic colonic resection with a definitive pathology of colonic lipoma. BACKGROUND Colonic lipomas are rare benign nonepithelial tumors of the colon. They begin to be symptomatic when they reach a certain size, although the presentation can vary. Different endoscopic and surgical treatment strategies have been reported in the literature. CASE REPORTS Four male patients who underwent laparoscopic colonic resection and had definitive diagnosis of colonic lipoma were included in this report. All patients were over 60 years old. The first case presented with massive rectal bleeding. Obstructive symptoms and intermittent bleeding were prominent in the second and third cases. Abdominal pain and discomfort was present in the forth case. In the first 2 cases, abdominal CTs were suggestive of colonic lipoma and laparoscopic ileocecal resection was performed. However, malignancy could not be ruled out in the other 2 cases due to large size and heterogeneous appearance of the lesions and inconclusive endoscopic biopsies consisted of ulcer with exudate and inflammatory cells. Laparoscopic left and right hemicolectomy was performed in the third and forth cases, respectively. There were no complications in any patients. CONCLUSIONS Laparoscopic resection can be the first choice in treatment of colonic lipomas with various presentations. Wider resections should be considered in cases with uncertain diagnosis.
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Affiliation(s)
- Deniz Eren Böler
- Department of General Surgery, Acıbadem University Medical Faculty, İstanbul, Turkey
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Affiliation(s)
- Vinay Goya
- Bronx Lebanon Hosptial Center/Albert Einstein School of Medicine Bronx, New York
| | - Pituck Ungsunan
- Bronx Lebanon Hosptial Center/Albert Einstein School of Medicine Bronx, New York
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Sugimoto K, Sato K, Maekawa H, Sakurada M, Orita H, Ito T, Saita M, Ikota M, Yoshida Y, Yamano M. Unroofing technique for endoscopic resection of a large colonic lipoma. Case Rep Gastroenterol 2012; 6:557-62. [PMID: 22949897 PMCID: PMC3432998 DOI: 10.1159/000342350] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 77-year-old man presented with repeated episodes of melena. He had a medical history of hypertension, atrial fibrillation and cardiogenic brain infarction and took medications, i.e. an antiplatelet agent. Laboratory data revealed iron deficiency anemia. Colonoscopy revealed a yellowish smooth submucosal tumor, 50 mm in diameter, on the Bauhin valve. The lesion was soft and compressible. The overlying mucosa was erosive. CT scan showed a uniform mass with very low density in the ascending colon, corresponding to the above-detected lesion. The clinical diagnosis of colonic lipoma was established. Using a 25 mm electrocautery snare (Olympus, Tokyo, Japan), we transected the upper portion of the mass to unroof the lesion. The mucosa layer was thick and hard. Fat tissue was observed extruding from the cut surface, consistent with the diagnostic hypothesis. After dissecting the overlying mucosa on the anal side by means of an IT knife (Olympus) in order to completely extrude the mass, the fat tissue was further exposed. It took about 26 min to perform the whole procedure. There were no procedure-related complications. Macroscopically, the resected lesion was a yellow solid tumor, 1.6 × 1.5 × 0.7 cm in diameter. Histopathologic examination of the excised specimen confirmed the diagnosis of a lipoma. The clinical course was uneventful. A follow-up endoscopy 1 month later showed a scarred mucosa at the resection site. Similarly, a follow-up CT scan 2 months later revealed no evidence of residual lipoma. The unroofing technique is safe, easy and suitable for the treatment of large lipomas.
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Affiliation(s)
- Kiichi Sugimoto
- Department of Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
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Large colorectal polyps--endoscopic polypectomy as an alternative to surgery. POLISH JOURNAL OF SURGERY 2012; 83:531-6. [PMID: 22189279 DOI: 10.2478/v10035-011-0084-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
UNLABELLED Endoscopic polypectomy of colorectal polyps is a common procedure. However, endoscopic treatment of large polyps (those with a diameter exceeding 2 cm) remains questionable. There is a serious risk of colorectal carcinoma presence inside these lesions, which eventually would require surgical intervention. Apart from this fact endoscopic polypectomy of large polyps is connected with substantial risk of complications, such as perforation and bleeding. Many patients with large colorectal polyps are qualified for surgical intervention. THE AIM OF THE STUDY was to determine the efficacy and safety of polypectomy of large colorectal polyps. MATERIAL AND METHODS The study presented results of endoscopic treatment in case of patients with large colorectal polyps at the Department of General and Colorectal Surgery, Medical University in Łódź. Patients were admitted to the hospital during the period between January, 2008 and January, 2010. The following parameters were analysed: location of polyps, percentage of high grade dysplasia, complete excision rate, and complications connected with polypectomy procedures. RESULTS During the analyzed period of time 488 endoscopic polypectomies were performed. Forty-three large colorectal polyps were removed (8.8%). Seven (16.3%) of them were classified as flat polyps. Out of 488 removed polyps, 39 were classified as adenomas with high grade dysplasia (7.9%), while 16 were large-exceeding 2 cm (37.2%). Considering the group of large polyps no invasive carcinoma case was detected. The radical excision rate for large pedunculated polyps was obtained in 88.8% (32/36) of cases. In case of flat adenomas the above-mentioned parameter was lower--57.1% (4/7). During polypectomy of large colorectal polyps one perforation was observed during the excision of a flat cecal polyp. In two cases immediate bleeding occurred (2/43). In both cases endoscopic treatment of bleeding proved sufficient. CONCLUSIONS Endoscopic polypectomy of large pedunculated polyps is a safe and efficient method, which makes it a rationale alternative for surgery. Polypectomy of flat adenomas is connected with a lower radical excision rate and higher risk of perforation.
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Bentama K, Chourak M, Chemlal I, Benabbou M, Raiss M, Hrora A, Sabbah F, Benamer A, Ahellat M. Intestinal subocclusion due to colonic lipoma: a case report. Pan Afr Med J 2011; 10:22. [PMID: 22187604 PMCID: PMC3224052 DOI: 10.4314/pamj.v10i0.72232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022] Open
Abstract
Colonic lipomas are rare benign tumors infrequently met in clinical practice. Most of them are asymptomatic making frequent their fortuitous discovery. The therapeutic approach to the fortuitous discovery of a lipoma is even less clear. The treatment depends essentially on the clinical picture, on the size of the lipoma and on its location. We report the case of a 31-year old woman, which sub-occlusive accidents events revealed a lipoma of the descending colon. The diagnosis was suspected on colonoscopy and segmental colectomy was performed. The diagnosis was confirmed by histological examination. We review the literature and discuss the clinical features, diagnosis and treatment of this uncommon disease.
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Affiliation(s)
- Kamal Bentama
- Surgical Clinic C, University Hospital Ibn Sina, Rabat, Morocco
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Howard N, Pranesh N, Carter P. Colo-colonic intusussception secondary to a lipoma. Int J Surg Case Rep 2011; 3:52-4. [PMID: 22288044 DOI: 10.1016/j.ijscr.2011.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 10/16/2011] [Accepted: 10/17/2011] [Indexed: 11/30/2022] Open
Abstract
We present a case of subacute obstruction in a 49 years old lady due to colo-colonic intussusception secondary to a lipoma. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.
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Affiliation(s)
- Nicholas Howard
- General Surgery Department, The Royal Liverpool University Hospital, Prescott Street, Liverpool L7 8XP, United Kingdom
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17
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Agrawal A, Singh KJ. Symptomatic intestinal lipomas: our experience. Med J Armed Forces India 2011; 67:374-6. [PMID: 27365853 PMCID: PMC4920661 DOI: 10.1016/s0377-1237(11)60090-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 04/30/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amit Agrawal
- Graded Specialist (Surgery), Armed Forces Clinic, Dalhousie Road, New Delhi – 10
| | - KJ Singh
- Associate Professor, Department of Surgery, AFMC, Pune – 40
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18
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Siddiqui MRS, Azeez A, Gyanti R, Zaborsky A, Hasan F. A case report of an endoscopically removed colonic lipoma. Magy Seb 2009; 62:347-349. [PMID: 19945937 DOI: 10.1556/maseb.62.2009.6.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Management of colonic lipomas is still debated due to rarity and lack of long term data primarily. We report a case of colonic lipoma removed endoscopically with synchronous polypectomy. This report discusses the various aspects to consider how to manage this neoplasia. Conventionally, lipomas greater than 2 cm are removed surgically. However, in selected cases, skilled endoscopists may remove larger colonic lipomas safely.
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19
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Féau S, Dorval E, Lecomte T. [Endoscopic mucosal resection of a polypoid sessile adenoma over a lipoma]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2009; 33:1012-1013. [PMID: 19767163 DOI: 10.1016/j.gcb.2009.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 03/05/2009] [Accepted: 03/10/2009] [Indexed: 05/28/2023]
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20
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Boyce S, Khor YP. A colonic submucosal lipoma presenting with recurrent intestinal obstruction attacks. BMJ Case Rep 2009; 2009:bcr11.2008.1199. [PMID: 21686420 DOI: 10.1136/bcr.11.2008.1199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Colonic submucosal lipomas are rare benign tumours of the colon, which may be discovered incidentally at colonoscopy, through imaging such as CT or at autopsy. These tumours can cause complications such as bleeding, intussusception and bowel obstruction. We describe the case of a patient in whom a small submucosal lipoma was identified at the time of colonoscopy and who did not receive follow-up treatment. The patient presented 1 year later with intussusception and obstruction resulting from this polyp and required urgent surgery. With the increasing use of colonoscopy and CT, such lesions are likely to be discovered more often. As complications can ensue, guidelines should be developed to advise on the management of such polyps in order to prevent consequent complications.
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Affiliation(s)
- Stephen Boyce
- Western General Hospital, Colorectal Unit, Crewe Road South, Edinburgh, EH4 2XU, UK
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21
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Naga M, Chakravorty A, Liyanage C, Grabham JA. A rare presentation of submucous colonic lipoma. Surgeon 2008; 6:191. [PMID: 18581758 DOI: 10.1016/s1479-666x(08)80123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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22
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[Colonic lipoma: case report and literature review]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2008; 32:521-4. [PMID: 18343069 DOI: 10.1016/j.gcb.2007.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 10/04/2007] [Accepted: 11/12/2007] [Indexed: 02/08/2023]
Abstract
Colonic lipoma is a rare benign tumor infrequently met in clinical practice. We report a case of symptomatic lipoma of the ascending colon in a 61-year-old woman. Diagnosis was suspected on CT scan. Colotomy with lipectomy was performed. The diagnosis was confirmed by histological examination. Reviewing the literature and combining with our experience, we discuss the clinical features, diagnosis and treatment of this uncommon disease.
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Nebbia JF, Cucchi JM, Novellas S, Bertrand S, Chevallier P, Bruneton JN. Lipomas of the right colon: report on six cases. Clin Imaging 2008; 31:390-3. [PMID: 17996601 DOI: 10.1016/j.clinimag.2007.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 04/23/2007] [Indexed: 01/12/2023]
Abstract
We report six cases of lipomas of the right colon, of which one was affected by two lesions. Two cases presented with episodes of partial occlusion; the others did not present with particular symptoms. The diagnoses were based on imaging by computed tomography, which demonstrated an intraluminal formation of fatty density, not associated with tissual components or hypervascularization.
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Affiliation(s)
- Jean-Francois Nebbia
- Service d'Imagerie Médicate, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet 2, route de Saint Antoine de Ginestiére, B.P. 3979, F-06202 Nice Cedex 3, France.
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Abstract
A case of intestinal obstruction caused by jejunal chondrolipoma in an 11-year-old boy is presented. To the best of our knowledge, this seems to be the first report of chondrolipoma arising from the small bowel in English language literatures.
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Affiliation(s)
- Hye-Ra Jung
- Department of Pathology, Keimyung University Dongsan Medical Center, Daegu 700-712, South Korea
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25
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Jovanović I, Pavlović A, Popović D, Pavlov M. Endoscopically removed giant submucosal lipoma. VOJNOSANIT PREGL 2007; 64:417-20. [PMID: 17687948 DOI: 10.2298/vsp0706417j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although uncommon, giant submucosal colon lipomas merit attention as they are often presented with dramatic clinical features such as bleeding, acute bowel obstruction, perforation and sometimes may be mistaken for malignancy. There is a great debate in the literature as to how to treat them. CASE REPORT A patient, 67-year old, was admitted to the Clinic due to a constipation over the last several months, increasing abdominal pain mainly localized in the left lower quadrant accompanied by nausea, vomiting and abdominal distension. Physical examination was unremarkable and the results of the detailed laboratory tests and carcinoembryonic antigen remained within normal limits. Colonoscopy revealed a large 10 cm long, and 4 to 5 cm in diameter, mobile lesion in his sigmoid colon. Conventional endoscopic ultrasound revealed 5 cm hyperechoic lesion of the colonic wall. Twenty MHz mini-probe examination showed that lesion was limited to the submucosa. Since polyp appeared too large for a single transaction, it was removed piecemeal. Once the largest portion of the polyp has been resected, it was relatively easy to place the opened snare loop around portions of the residual polyp. Endoscopic resection was carried out safely without complications. Histological examination revealed the common typical histological features of lipoma elsewhere. The patient remained stable and eventually discharged home. Four weeks later he suffered no recurrent symptoms. CONCLUSION Colonic lipomas can be endoscopically removed safely eliminating unnecessary surgery.
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Affiliation(s)
- Ivan Jovanović
- Clinical Center of Serbia, Clinic of Gastroenterology and Hepatology, Belgrade, Serbia.
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Katsinelos P, Chatzimavroudis G, Zavos C, Paroutoglou G, Papaziogas B, Kountouras J. A novel technique for the treatment of a symptomatic giant colonic lipoma. J Laparoendosc Adv Surg Tech A 2007; 17:467-9. [PMID: 17705728 DOI: 10.1089/lap.2006.0208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Submucosal lipomas are usually harmless neoplasms arising from submucosal adipocytes. They are found most commonly in the colon, but may develop in any part of the gastrointestinal tract. Most colonic lipomas are asymptomatic and need no treatment, whereas larger ones (>2 cm) may present with abdominal pain, changes in bowel habits, rectal bleeding, and intussusception or prolapse. The literature on the endoscopic resection of colonic lipomas is limited owing to the increased risk of colonic perforation. In this paper, we describe a novel technique for the treatment of colonic obstruction resulting from a giant lipoma by placing two large clips at the narrow base of the lipoma and performing multiple cuttings on the mucosa covering the fatty tissue by using a needle-knife to facilitate the fat's discharge into the colon's lumen. Our case showed that the endoclipping of semi- or pedunculated large colonic lipomas not amenable for endoloop ligation and associated with cuttings of the mucosa covering the fat is a promising new technique, which avoids the risk of perforation or bleeding of the snare cautery, especially in high-risk patients.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G. Gennimatas General Hospital, Thessaloniki, Greece
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Katsinelos P, Chatzimavroudis G, Zavos C, Pilpilidis I, Lazaraki G, Papaziogas B, Paroutoglou G, Kountouras J, Paikos D. Cecal lipoma with pseudomalignant features: A case report and review of the literature. World J Gastroenterol 2007; 13:2510-3. [PMID: 17552037 PMCID: PMC4146772 DOI: 10.3748/wjg.v13.i17.2510] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colonic lipoma is a well-documented benign neoplasia, endoscopically appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopically performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, 54635, Thessaloniki, Greece.
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Yu HG, Ding YM, Tan S, Luo HS, Yu JP. A safe and efficient strategy for endoscopic resection of large, gastrointestinal lipoma. Surg Endosc 2007; 21:265-269. [PMID: 17122972 DOI: 10.1007/s00464-006-0059-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 04/27/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign, slowly growing, submucosal tumors, which may cause gastrointestinal bleeding, anemia, intussusception, and bowel obstruction. The aim of this study is to explore the safe and effective strategy for endoscopic removal of large GI lipomas. METHODS During last 10 years, fifteen large and symptomatic GI lipomas were resected under endoscopy in our hospital. In them, two large lipomas with small stalk (< 2 m in diameter) were resected by polypectomy; ten large lipomas with base size greater than 2 cm in diameter were removed using a "subtotal resection." Three other large lipomas with small stalk (< 2 m in diameter) were resected by multistep resection. Endoscopic ultrasonography (EUS) and miniprobe endoscopic ultrasound were performed in six cases from January 2000 to July 2004 to confirm that those lesions were lipomas that were superficial to the muscularis propria. RESULTS All 15 lesions were successfully removed and were histopathologically confirmed to be lipomas. No severe complications, such as perforation or hemorrhage, developed after endoscopic removal. No recurrence was observed after 1-8 years follow-up endoscopic examination. CONCLUSIONS Various, large GI lipomas can be removed safely by electrosurgical snare resection under endoscopy following the guidance of the present therapeutic strategy.
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Affiliation(s)
- H-G Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, 430060, Wuhan, People's Republic of China.
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Tzilinis A, Fessenden JM, Ressler KM, Clarke LE. Transanal resection of a colonic lipoma, mimicking rectal prolapse. ACTA ACUST UNITED AC 2004; 60:313-4. [PMID: 14972264 DOI: 10.1016/s0149-7944(02)00729-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Colonic lipomas are benign tumors usually asymptomatic. Occasionally, they may cause symptoms such as bleeding, intussusception, obstruction, or rectal prolapse. METHODS We present a 44-year-old African-American female that presented with an 8 cm colonic lipoma protruding through the anal verge. We also reviewed all the reported cases in the English literature. RESULTS The patient was treated successfully with transanal resection, which has rarely been done before for this large a tumor. CONCLUSIONS Transanal resection of large benign tumors of the rectosigmoid is possible.
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Affiliation(s)
- Argyrios Tzilinis
- Department of Surgery, Mercy Catholic Medical Center, Philadelphia, Pennsylvania, USA.
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Bibliography. J Laparoendosc Adv Surg Tech A 1998; 8:251-3. [PMID: 9755921 DOI: 10.1089/lap.1998.8.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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