Successful Endoscopic Submucosal Dissection of a Large Terminal Ileal Lipoma

Abstract

A 78-year-old woman who had recurrent right lower abdominal pain for about 1 year underwent computed tomography (CT) because of a follow-up observation 1 year after right breast cancer surgery. CT revealed a tumor in the colon. The patient was referred to our hospital for detailed examinations. An abdominal CT showed a low-density tumor of approximately 30 mm in the ascending colon, and the CT density inside the tumor was same as that of fatty tissues. A subsequent colonoscopy showed a submucosal tumor (SMT) in the proximal ascending colon developing from the terminal ileum. A colonoscopic ultrasonography revealed that the SMT was a high-echoic mass mainly localized in the submucosal layer. Based on the findings from CT, colonoscopy, and colonoscopic ultrasonography, the SMT was diagnosed as a pedunculated lipoma originating from the terminal ileum and treated with endoscopic submucosal dissection (ESD) because of recurrent abdominal pain. The 40-mm tumor was resected en bloc without complications. ESD may be more appropriate than polypectomy and surgery for removal of small intestinal tumors, because ESD allows direct visualization of the cutting line and exactly dissects the submucosal layers without damaging the muscular layers. ESD is a potentially useful treatment to remove intestinal lipomas.

Spontaneous peeled ileal giant lipoma caused by lower gastrointestinal bleeding

“…Generally, intestinal lipoma is seen as submucosal masses with round or hemispherical shapes, a smooth surface, well-demarcated margin, and/or encapsulated yellowish surface. [ 13 , 14 , 20 ] However, this case did not show this form, and instead showed an interesting endoscopic findings with more than one-half of the surface peeling off and ulceration. In addition, the cushion and pillow signs, which are mainly seen in lipoma, [ 21 ] were not clear and did not help endoscopic diagnosis.…”

“…[ 20 ] The endoscopic treatment of patients with symptomatic small bowel lipoma is an alternative if small bowel lipoma can be removed by endoscopic resection. [ 13 , 14 , 22 ] In the present case, the patient underwent an elective laparoscopic ileocecectomy because the lipoma of the terminal ileum was considered as the lower GI bleeding source; there was a possibility of obstruction or intussusception because of large size; and there was a malignant potential in endoscopic findings. Histopathological findings revealed that the submucosal lipoma consisted of mature fat.…”

“…Conventional endoscopic findings of the ileum located in the lipoma are rarely reported, but there are a few reports of this unique type. [ 13 , 14 ] These cases involve those of endoscopic removal of the lipoma with an intact mucosal surface at the terminal ileum. Unlike these cases, the mucosal surface of the terminal ileal mass in this case had peeled naturally and an ulcer had formed.…”

“…Therefore, endoscopic characteristics of SETs in the terminal ileum are rarely reported except in case reports. [ 13 , 14 ] For this reason, little is known about the endoscopic appearance of SETs in the terminal ileum. Therefore, we apply the endoscopic characteristics of SETs reported in the stomach, esophagus, and duodenum in most cases.…”

Altmış Sekiz Kolonik Lipomlu Olgunun İncelenmesi

“…2 cm'den büyük veya semptomatik lipomların tedavisinde diğer bir alternatif yöntem ise endoskopik olarak bu lipomların rezeksiyonudur. Bizim çalışmamızda, bu şekilde tedavi edilen bir olgu olmamakla birlikte literatürde büyük kolonik ve ileal lipomların endoskopik rezeksiyon ile başarılı şekilde tedavisini anlatan çalışmalar bulunmaktadır (18).…”