Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma

Abstract

Rationale:Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published.Patient concerns:We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5 × 4.5 × 3.5 cm) was detected at the 15th centimetre of the anal canal via an electronic colonoscope. At the initial part of the rectum, intussusception caused by a 6.5-cm fat-density mass was observed via abdominal contrast-enhanced computed tomography.Diagnosis:Upper rectal intussusception caused by a giant rectal lipoma.Interventions:Due to the large size of the polyp, an endoscopic polypectomy could not be performed. We performed laparoscopic segmental resection of the rectum (with preservation of the left colic artery [LCA]).Outcomes:The patient was discharged on the 7th postoperative day without any complications, was monitored on a regular basis at our outpatient department and was free of symptoms at a 3-month follow-up visit.Lessons:Laparoscopic segmental resection of the rectum with LCA preservation is safe and feasible for the treatment of upper rectal intussusception caused by a giant rectal lipoma.

Rectum lipoma incarcerated in anus as a cause of abundant rectorrhagia

“…Intussusception, in addition to rectal bleeding, is the rectal lipoma most important urgent complication 13 . In adult patients, the incidence of intussusception is about 1% 4 . Preoperative diagnosis of lipoma can be made on the basis of radiographic findings -computed tomography and magnetic resonance imaging and during colonoscopy.…”

“…Rectal lipomas account for 5% of all lipomas in the gastrointestinal tract 3 . They are the third most prevalent among all benign tumors in the rectum, after hyperplastic polyps and adenomas 4 . In most cases lipomas are incidental findings made during diagnostic procedures and surgical interventions.…”

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.…”

Splenic flexure colonic lipoma causing intussusception

“…2 Approximately one fourth of colonic lipomas are symptomatic, especially those with a size above 2 cm. 3,4 Symptoms range from abdominal pain, constipation, lower gastrointestinal bleeding to intussusception. 4,5 Case presentation A 51-year-old previously healthy male with no significant medical or surgical history presented with intermittent abdominal pain and repeated bloody stools.…”

“…3,4 Symptoms range from abdominal pain, constipation, lower gastrointestinal bleeding to intussusception. 4,5 Case presentation A 51-year-old previously healthy male with no significant medical or surgical history presented with intermittent abdominal pain and repeated bloody stools. He also complained of abdominal distension.…”