Coloanal intussusception in adults due to lipoma / Intussuscepção colo-anal decorrente de lipoma em adulto

ABSTRACT Adult intussusception is a rare condition. But coloanal intussusception is an exception. Malignant lesions are the most common cause of colonic intussusception, and in this aspect, differ from childhood intussusception. We present a case wherein the patient had a lipoma of the sigmoid colon that caused an immense prolapse through the anus. Very few cases of coloanal intussusception are reported in adults, and we discuss the diagnostic tools and the management of this rare surgical entity.

RESUMO A intussuscepção no adulto é uma entidade rara. Mas a intussuscepção colo-anal é uma exceção. Lesões malignas são a causa mais comum de intussuscepção colônica e, neste aspecto, difere da intussuscepção infantil. Apresentamos um caso de lipoma do cólon sigmoide que causou um prolapso imenso através do ânus. Muito poucos casos de intussuscepção colo-anal foram relatados em adultos e discutimos as ferramentas diagnósticas e o tratamento dessa entidade cirúrgica rara.

Lipomas múltiples en colon. A propósito de un caso / MULTIPLE LIPOMAS COLON. REPORT OF A CASE

Los lipomas del colon son neoplasias benignas subepiteliales,poco frecuentes en este órgano, solo un 10% se presenta como lesiones múltiples y su localización predominante es el colon derecho. Su prevalencia es similar tanto en hombre y en mujeres, suelen ser lesiones asintomáticas y son diagnosticadas incidentalmente; ocasionalmente cuando son mayores de 2 cm la sintomatología es dolor abdominal, obstrucción intestinal, rectorragia o alteración del hábito evacuatorio. Se presenta el caso de paciente femenino de 78 años quien inicia enfermedad actual 12 meses previos a la consulta, presentando cambio de hábito evacuatorio caracterizado por estreñimiento, dolor abdominal difuso tipo cólico, y pérdida de peso no cuantificada asociada a hiporexia. Exámenes de laboratorio reportaron: hemoglobina 10.9 g/dl, hematocrito 38.6% (VCM: 72), leucocitos 9.600 ml/mm3, eosinófilos 21% (eosinofilia moderada), coproanálisis sin alteraciones. Debido a la eosinofilia se le solicita serología para toxocariasis resultando positiva. Endoscopia digestiva superior: hernia hiatal tipo I y gastropatía eritematosa antral, Biopsia: gastritis crónica no atrófica. Endoscopia digestiva inferior: se observan 5 lesiones elevadas entre 3 y 5 cms de diámetro, redondeadas, péndulas, cubierta con mucosa de aspecto normal, de color amarillo, con signo del “cojín”presente, distribuidas en colon transverso, descendente y sigmoides sugestivas de lipoma, además diverticulosis en sigmoides. Se indicó tratamiento con laxante osmótico y antiparasitario presentando mejoría de los síntomas. Actualmente la paciente presenta hemoglobina en 12g/dl, eosinófilos 3% y normalización de la frecuencia evacuatoria y remisión del dolor abdominal.

Colonic lipomas are rare benign neoplasms; approximately 10% present as multiple lesions. The prevalence is equal in both men and women, presenting usually as asymptomatic lesions, which are diagnosed incidentally. However, when they are large (> 2cm) they may present with abdominal pain, intestinal obstruction, rectal bleeding or altered bowel habits. We report on a 78 years old female patient with a 12 months history of changing bowel habits characterized by constipation, diffuse colic abdominal pain, and weight loss associated with hiporexia. Her laboratory tests report eosinophilia: 21% of 9600/mm3 WBC, hemoglobin 10.9 g/dl, hematocrit 38.6%, stool tests were normal. Serology for toxocariasis was positive. Upper gastrointestinal endoscopy revealed hiatal hernia and erythematous gastric mucosa; biopsy was compatible with chronic atrophic gastritis. Colonoscopy revealed 5 raised lesions between 3 and 5cm in diameter, round, pendulous, covered with normal-appearing yellowish mucosa, ("pad sign"). This distribution in the transverse, descending and sigmoid colon is suggestive of lipomas coexisting with sigmoid diverticulosis. Treatment was indicated: osmotic laxative and anti-parasitic medications with symptomatic improvement. Currently the patient has 12g/dl of hemoglobin, and 3% eosinophils with normalization of her bowel movements.

Autoamputation of a Giant Colonic Lipoma

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously.

Endoscopic Resection of a Large Colonic Lipoma / 대한소화기내시경학회지

Although colonic lipomas constitute the most common nonepithelial neoplasms of the gastrointestinal tract, colonic lipomas are rare benign tumors. Most colonic lipomas are asymptomatic and are incidentally identified at the time of endoscopy or surgery. Lipomas may cause symptoms such as bleeding, obstruction or intussusception when the size of a tumor exceeds 2 cm. Surgical resection is recommended for larger lipomas to relieve symptoms or exclude a malignancy. There are few published reports on the endoscopic removal of colonic lipomas. Endoscopic snare polypectomy has been used to treat clinically symptomatic colonic lipomas. However, removal of lipomas 2 cm or greater in diameter has been associated with a greater risk of perforation. Using a detachable snare or hemoclipping may reduce the risk of complications after a polypectomy. We report a case of a large colonic lipoma that was treated with endoscopic polypectomy using a detachable snare and hemoclipping.

Lipoma de la válvula ileocecal: informe de un caso clínico y revisión de la literatura / Ileocecal valve lipoma: case report and review of the literature

Introducción: los lipomas son los tumores benignos más frecuentes en tubo digestivo y hasta 50 % se encuentra en el colon. La mayoría son submucosos y varían de acuerdo a su incidencia, localización, sintomatología y patogénesis, lo que dificulta su diagnóstico. Nuestro objetivo fue conocer las diferentes manifestaciones clínicas causadas por un lipoma en la válvula ileocecal, y hacer una revisión de la literatura de esta localización poco frecuente. Caso clínico: mujer de 78 años que presentó cuadros repetidos de oclusión intestinal parcial con distensión abdominal, constipación y obstipación. Se realizó colonoscopia que mostró tumoración submucosa de 30 mm en válvula ileocecal; la tomografía computarizada de abdomen mostró tumoración nodular de densidad grasa en válvula ileocecal. La paciente fue sometida a laparotomía exploradora y cecotomía, donde se identificó y resecó tumoración submucosa, la cual fue enviada a estudio transoperatorio; dado que se trató de una tumoración benigna, se respetó la válvula ileocecal y se realizó cierre primario. El reporte histopatológico definitivo fue lipoma, negativo para malignidad. Conclusiones: es importante conocer las distintas formas de presentación de los lipomas, ya que fácilmente pueden confundirse con lesiones malignas (sobre todo si existe ulceración de la mucosa) y someter al paciente a procedimientos mayores. Sólo deben resecarse si producen síntomas o son mayores a 2 cm.

BACKGROUND: Lipomas are the most frequent benign tumors of the digestive tract and 50% are localized in the colon. Most are found submucosally and may vary in their incidence, localization, symptoms and pathogenesis, making diagnosis difficult. We undertook this study to learn the different presentations of an ileocecal valve (ICV) lipoma and conduct a review of the literature due to this uncommon location. CASE PRESENTATION: We present the case of a 78-year-old female with intermittent small bowel occlusion, abdominal distention and constipation. Colonoscopy showed a submucous tumor at the ICV, CT scan showed a tumor at the ICV with fat density. Laparotomy was performed with primary resection of the lesion by cecotomy, frozen section was reported as nonmalignant so a primary closure without ICV involvement was achieved. Definitive pathology revealed a benign lipoma. CONCLUSION: It is important to know the different presentations of these benign tumors because if there is mucosal ulceration they can be mistaken for a malignant lesion and lead to greater resections. Resection is necessary if they are symptomatic or >2 cm.