An Ulcerated Large Colic Lipoma Causing Rectorrhagia Treated With Endoscopic Loop-Assisted Resection

Abstract

Colonic lipomatous polyps are often an incidental finding during colonoscopy. Generally, these types of polyps can cause gastrointestinal bleeding when they are larger than 4 cm in size. Some case reports have documented the occurrence of overlying adenomatous formations in the apical portion, as well as ulcerated mucosa. There is currently no standardized endoscopic removal technique for their treatment. In this report, we present a case of a large and ulcerated lipoma causing rectorrhagia, which was successfully treated with endoscopic en-bloc resection and endoloop placement.

Giant Ulcerated Colonic Lipoma in an Asymptomatic Patient

“…Expert opinions suggest treatment of most small colonic lipomas with endoscopic resection, while giant lipomas may warrant surgical intervention. However, in selected cases, endoscopic resection of giant lipomas may be the preferred method to prevent unnecessary surgery [ 8 ]. The proposed criteria for surgical management include lipomas larger than 4 cm with a sessile appearance or limited peduncle, lipomas presenting with severe symptoms such as intussusception, and those with involvement of the deeper mucosal layers [ 9 ].…”

Management Options of Giant Colonic Lipomas

“…As the management of a colonic lipoma with resultant colocolonic intussusception merits surgical intervention, it is imperative that accurate identification and diagnosis of the underlying etiology be made [ 6 ]. However, the management of colonic lipomas in non-emergent scenarios remains a topic of discussion as advancements in endoscopic and surgical techniques have been made and intervention on asymptomatic lipomas remains a topic of debate [ 7 - 11 ]. In this report, we present our institution’s experience managing giant colonic lipomas with a variety of presentations and associated intussusception whilst also reviewing current management approaches in the literature.…”