Surgical Strategy for Colonic Intussusception Caused by a Giant Colonic Lipoma: A Report of Two Cases and a Review of the Literature

Abstract

A colon lipoma is a remarkably rare tumor. In most cases, the tumors are asymptomatic and small in size, need to be differentiated from malignant tumors, and do not need any special treatment. Selection of the right surgical strategy depends on the status of bowel, as well as the size and the location of tumor. We encountered two patients with giant submucosal lipomas that had induced intussusceptions: one with a lipoma in the transverse colon and the other with a lipoma in the ascending colon. The diagnoses were made by using histological examinations. We report the clinical features, diagnoses, and treatments of, as well as our experience with, these two uncommon cases, and we present a review of the literature on this subject.

Colonic intussusception caused by an ulcerating lipoma in an adult: A rare case report and literature review

“…Though spontaneous expulsion of lipomas through the rectum has been reported [5,11,14], a small subgroup requires surgical intervention, including those with suspected malignancy, symptomatic lipomas, surgical emergencies such as intussusceptions, and obstruction with ulceration and bleeding [7]. The management strategy for colonic lipomas mainly depends on the size, clinical symptoms, and preoperative diagnosis.…”

“…Colonic lipomas are benign submucosal tumors composed of mature adipose tissue and were first reported by Bauer in 1757 [2,3]. After reviewing the literature for the most recent cases (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13], we concluded that most lipomas range in size from 2 mm to 30 cm and that the majority of patients are between 50 and 70 y of age, with a female predominance. Colonic lipomas are typically asymptomatic or minimally symptomatic when less than 2.0 cm in size, and they are usually detected during endoscopy, surgery, or autopsy.…”

“…Barium enemas usually show ovoid, welldemarcated filling defects and smooth sub-mucosal masses [7][8][9]. The "squeeze sign" describes when a lipoma adopts a fusiform appearance with colonic peristalsis; such deformation can result from external pressure or peristalsis.…”

“…In contrast, large lipomas generally produce symptoms, including abdominal pain, diarrhea, bowel obstruction, and obstipation. These symptoms are primarily caused by chronic intermittent ileocolonic or colo-colonic intussusceptions [5][6][7][8]. Furthermore, large lipomas can have ulcerations and may cause gastrointestinal bleeding as a result of pressure necrosis in the overlying mucosa [4].…”

“…On ultrasound, an abdominal mass with a "donut" or "target" sign in which the outermost layer represents the sheath and the multilayer ring structure represents the invaginated intestinal segment, is pathognomonic for the presence of an intussusception [13,14]. Recent reports have shown that abdominal CT scanning has a diagnostic sensitivity of 58-100% and a specificity of 57-71%, and this method is considered the "gold standard" for diagnosis [6,7]. CT can clearly reveal the typical characteristics of uniform tumor density with thin septa, clear borders, and no enhancement.…”