Colonic lipomas are the most widespread non-epithelial tumours of the large bowel. They often present with absent, non-specific or intermittent symptoms. Intussusception is the most common complication that may occur as a result of such a lesion. We present the case of a young female patient with a history of intermittent abdominal pain associated with nausea. She presented to the emergency department with subacute large bowel obstruction. A diagnosis of colo-colic intussusception due to a large descending colonic lipoma was confirmed on CT scan. The patient underwent a laparoscopic assisted submucosal excision of the lipoma. We discuss this unique operative technique as well as preoperative investigations and histopathology findings. Although successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma.

Background International medical graduates (IMGs) have a primary medical qualification obtained from outside their country of practice. In the United Kingdom (UK), postgraduate medical training after foundation years involves obtaining a national training number (NTN) in their specialty of choice by national selection. In this paper, we aim to quantify how IMGs feel to obtain an NTN and what unique obstacles they may face in doing so. Materials and methods A survey with a combination of closed and open-ended questions was circulated to IMGs via social media and text message. The survey was aimed at those IMGs practising at a middle grade (non-consultant) level, whether they had obtained a training number or not. Data collected included demographics, years of postgraduate experience before UK arrival, number of attempts at obtaining a training number, and the most significant perceived difficulty to obtaining a training number. We also asked whether difficulties in obtaining a training number would cause IMGs to contemplate changing specialty. Data from the survey responses were analysed using SPSS 22. Results Out of a total of 203 doctors approached, 197 responded, of which the majority were male. All responders had at least five years of postgraduate experience before relocating to the UK. Only 56 (28.8%) had a training number at the time of the survey. Almost all the responders had made at least one unsuccessful attempt to obtain a training number. In addition, 152 (76.6%) of responders felt that timely career progression in the UK was unlikely without having a training number. 57 (29.6%) of responders considered changing specialty due to inability to obtain a training number. Conclusion Obtaining an NTN remains a crucial goal among IMGs in the UK, despite the obstacles and repeated failures in doing so.

Lipomas are the most common non-epithelial tumours of the colon. Nevertheless, symptomatic colonic lipomas are a rare entity in adults. Intussusception is the commonest complication of submucosal lipomas and often presents with absent, non-specific or intermittent symptoms, hence the diagnosis is challenging.  In non-emergency situations, most patients undergo computed tomography scan as well as endoscopic evaluation of the colon prior to any surgical intervention. While successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma through a colotomy. We present the case of a young female patient with few weeks history of intermittent abdominal pain associated with nausea. She had previously undergone various investigations including colonoscopy and was awaiting an elective left hemicolectomy. She presented to our Emergency department with subacute large bowel obstruction. A CT scan confirmed the diagnosis of colo-colic intussusception due to a large descending colon lipoma. The patient underwent a laparoscopic assisted procedure - following laparoscopic colonic mobilisation, submucosal excision of the large lipoma was performed through a colotomy placed through the taenia on the opposite wall. The mucosal defect and colotomy were closed following the excision. The patient recovery was uneventful and histopathology of the specimen confirmed the diagnosis.