An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

Introduction: Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are...

Full description

Saved in:
Bibliographic Details
Published in:GE Portuguese journal of gastroenterology 2022-01, Vol.29 (1), p.45-50
Main Authors: João, Mafalda, Cunha, Inês, Gravito-Soares, Elisa, Gravito-Soares, Marta, Amaro, Pedro, Figueiredo, Pedro
Format: Article
Language:English
Subjects:
Abdomen
Asymptomatic
Biopsy
Body fat
Case reports
Clinical Case Study
Colon
colonic lipoma
Colonoscopy
Decision making
Endoscopy
Hernias
Intestinal obstruction
intussusception
Necrosis
single-incision needle-knife biopsy technique
Surgery
Tomography
Tumors
Ultrasonic imaging
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction: Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required. Case Report: A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic. Discussion/Conclusion: Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.
ISSN:2341-4545
2387-1954
DOI:10.1159/000513967