Clin Endosc.  2012 Jun;45(2):165-168. 10.5946/ce.2012.45.2.165.

A Case of Giant Lipoma Causing Chronic Recurrent Intussusception of the Colon

• Lee CS
• Lee MJ
• Kim KL
• Kim YS
• Baik GH
• Kim JB
• Kim DJ
• Han SH

• KMID: 2048856
• DOI: http://doi.org/10.5946/ce.2012.45.2.165

Abstract

Colonic lipomas, which often occur in elderly women, usually have small size and occur mainly in the cecum and ascending colon. Most colonic lipomas are asymptomatic and identified incidentally at the time of endoscopy or surgery. However, they may cause symptoms such as bleeding, obstruction or intussusception as their size increases. Intermittent episodes of intussusception are uncommon but may be caused by large pedunculated lipoma. In a 68-year-old woman suffering intermittent abdominal pain, 5.5x4.5x3.8-cm huge mass was found by colonoscopy at proximal ascending colon, which was intussuscepted to proximal transverse colon on abdominal computed tomography. Segmental right colonic resection was conducted. We report a case of symptomatic giant pedunculated colonic lipoma causing intussusception requiring surgical intervention, with a successful recovery after surgery.

Keyword

Intussusception; Colon; Lipoma

MeSH Terms

Abdominal Pain
Aged
Cecum
Colon
Colon, Ascending
Colon, Transverse
Colonoscopy
Endoscopy
Female
Hemorrhage
Humans
Intussusception
Lipoma
Stress, Psychological

Figure

• 

  Fig. 1 Colonoscopic findings. (A) Huge, round, hyperemic mass covered with superficial ulcer is observed at proximal ascending colon. On the center of ulcer, the exposed vessels are seen. (B) It shows another small ulcer near the base of the mass, and inflammated hyperemic mucosa is seen on the body of the mass.

• 

  Fig. 2 Abdominal computed tomography findings. (A) It shows a concentric multi-layered mass at the proximal A-colon, which extended to proximal T-colon, and 6×4 cm sized well defined low density mass in proximal T-colon, suggesting colo-colic intussusception caused by lipoma. (B) In the coronal images, introcession from the cecum and shortened A-colon are seen.

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  Fig. 3 Gross findings. (A) The polypoid submucosal mass is identified in the cecum. (B) The mass is confined to the submucosa, and the cut surface appears bright yellow and soft.

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  Fig. 4 Pathologic finding. The tumor consists of the mature adipocytes with focal fat necrosis, supporting the lipoma (H&E stain, ×100).

Reference

1. Ladurner R, Mussack T, Hohenbleicher F, Folwaczny C, Siebeck M, Hallfeld K. Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance. Surg Endosc. 2003; 17:160. PMID: 12399859.

2. Suárez Moreno RM, Hernández Ramírez DA, Madrazo Navarro M, Salazar Lozano CR, Martínez Gen R. Multiple intestinal lipomatosis. Case report. Cir Cir. 2010; 78:163–165. PMID: 20478119.

3. Bardají M, Roset F, Camps R, Sant F, Fernández-Layos MJ. Symptomatic colonic lipoma: differential diagnosis of large bowel tumors. Int J Colorectal Dis. 1998; 13:1–2. PMID: 9548092.

4. Rogy MA, Mirza D, Berlakovich G, Winkelbauer F, Rauhs R. Submucous large-bowel lipomas: presentation and management. An 18-year study. Eur J Surg. 1991; 157:51–55. PMID: 1675882.

5. Triantopoulou C, Vassilaki A, Filippou D, Velonakis S, Dervenis C, Koulentianos E. Adult ileocolic intussusception secondary to a submucosal cecal lipoma. Abdom Imaging. 2004; 29:426–428. PMID: 15024521.

6. Gayer G. Intussusception: not only a childhood disease. Isr Med Assoc J. 2001; 3:962. PMID: 11794926.

7. Siegal A, Witz M. Gastrointestinal lipoma and malignancies. J Surg Oncol. 1991; 47:170–174. PMID: 2072700.

8. Bahadursingh AM, Robbins PL, Longo WE. Giant submucosal sigmoid colon lipoma. Am J Surg. 2003; 186:81–82. PMID: 12842756.

9. 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.

10. Seong SG, Kim DK, Park KH, Park SK, Ryu CS, Choi DY. A case of small bowel lipoma resulting intussusception. Korean J Gastroenterol. 1997; 29:543–548.

11. Zhang H, Cong JC, Chen CS, Qiao L, Liu EQ. Submucous colon lipoma: a case report and review of the literature. World J Gastroenterol. 2005; 11:3167–3169. PMID: 15918213.

12. Wang N, Cui XY, Liu Y, et al. Adult intussusception: a retrospective review of 41 cases. World J Gastroenterol. 2009; 15:3303–3308. PMID: 19598308.

13. Tamura S, Yokoyama Y, Morita T, Tadokoro T, Higashidani Y, Onishi S. "Giant" colon lipoma: what kind of findings are necessary for the indication of endoscopic resection? Am J Gastroenterol. 2001; 96:1944–1946. PMID: 11419863.

14. Bae JH, Han DS, Baek CH, et al. A case of giant pedunculated submucosal lipoma causing intussusception of the colon. Korean J Gastrointest Endosc. 2006; 32:147–151.