Jamie M O’Rear, MD, Andres E Giovannetti, Rami E Lutfi, MD, Francisco A Quinteros, MD. Mercy Hospital and Medical Center
Colonic lipomas account for only 0.3% of cases treated for colorectal disease. These benign lesions may go unnoticed, but they cause clinically significant symptoms when they increase in size larger than 3.5 cm. We present a case of intussusception caused by colonic lipoma treated with laparoscopic hemicolectomy.
A 75 year-old-male presented with symptoms of chronic partial bowel obstruction. CT demonstrated a fat-containing lesion telescoping into the transverse colon, with the position of the right colon shifted to the center of the abdomen. On colonoscopy, a lesion was visualized at the splenic flexure, preventing passage of the scope. Biopsy revealed only ulcerated colonic mucosa.
The patient was consented for laparoscopic hemicolectomy. Upon entering the abdomen, a soft tissue mass was appreciated in the left upper quadrant, and the right colon was clearly intussuscepted into the transverse colon. Before proceeding with resection, it was necessary to re-establish normal anatomy. Omental adhesions wrapped around the mass were lysed. The duodenum was carefully avoided when scoring the peritoneum of the displaced right colon. The white line of Toldt, which was sweeping over the duodenum, was released to achieve mobilization necessary to reposition the ascending colon on the right side of the abdomen. The operation then proceeded in the fashion of a standard right hemicolectomy.
The right colon, containing a 6.5 cm submucosal lipoma, was resected, along with 13 reactive lymph nodes. The patient recovered uneventfully, and his symptoms of anorexia, abdominal pain, and constipation resolved.
Colonic lipomas are difficult to definitively diagnose preoperatively because malignancy cannot be excluded. CT typically shows a smooth mass with fat density. Biopsy may be difficult due to the submucosal position of most lesions. Lipomas greater than 2 cm should be resected, because larger lesions can cause irregular bowel movements, pain, bleeding, or intussusception, as seen with this patient. Endoscopic resection is controversial because fat is an inefficient conductor of heat, increasing the risk of hemorrhage or perforation. Surgical resection is the treatment of choice for colonic lipomas. We present a case of successful laparoscopic resection of this relatively uncommon pathology in a patient presenting with the interesting anatomic challenge of intussuscepted right colon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87100
Program Number: V230
Presentation Session: Thursday Video Loop (Non CME)
Presentation Type: VideoLoop