Rare Mesenchimal Tumors of The Large Bowel: Colonic Lipomas

Abstract

Objective: Colonic lipomas are the second most common benign tumor after polyps. Although large lipomas cause bleeding, perforation and invagination, they are generally asymptomatic. Symptomatic lipomas are treated with surgical and endoscopic methods. By presenting our case series on colonic lipomas in the light of the literature, we aimed to show that most of the lipomas, albeit large, do not require intervention. Methods: Colonoscopy procedures performed between 01.06.2013 and 01.03.2019 due to colorectal cancer (CRC) screening and follow-up, rectal bleeding, changes in bowel habit and anemia were included in the study. Data including age, gender, indication and colonoscopy findings of patients with lipomas larger than two cm in their large intestines were recorded. Results: Colonoscopy was performed on 4072 patients. Colonic lipoma larger than 2 cm was detected in 17 patients. Ten patients (58.8%) were female and seven patients (41.2%) were male. The mean age was 60.8 ± 8.8 years. Colonoscopy was performed in seven patients (41.2%) for CRC scanning, two patients (11.8%) for CRC follow-up, three patients (17.6%) for change in bowel habit, three patients (17.6%) for rectal bleeding, and two patients (11.8%) for anemia. The mean lesion size was 3.7 ± 1.5 cm. Lesions were seen in 14 lipomas (56%) in the right colon, six lipomas (24%) in the transverse colon, and five lipomas (20%) in the left colon. Conclusion: Colon lipomas are often not recognized or misdiagnosed due to factors such as insufficient colon cleansing or insufficient right colon intubations due to the patient’s inability to tolerate, insufficient attention and experience of the endoscopist. With the increase of awareness about colonic lipomas, we believe that only a few of the lesions diagnosed will require an invasive procedure.