Large submucosal lipoma of the left transverse colon causing intermittent obstruction

M. Peter, A. Meyer, F. Pugin, B. Egger

Objective

Lipomas are the second most common benign tumors arising in the small bowel and the most common type of submucosal polyps in the colon. They are most often found incidentally in the colon, but may develop in any part of the gastrointestinal tract. Most of them are asymptomatic but some may present with gastro-intestinal symptoms such as abdominal pain, pseudo-obstruction or changes in bowel habits. The caecum and ileocaecal valve are most commonly affected (45.4%), followed by the rectum and sigmoid (30.3%), descending (15.2%) and transverse colon (9.1%). Lesions larger than 2cm often complicate with GI bleeding.

Methods

A 52-year-old patient was hospitalized with pain in the left flank and intermittent bloating. Blood tests only revealed an elevation of the CRP (24 mg/L) without any other perturbation. A large polyp in the left part of the transverse colon associated with an intussusception of the splenic angle of the transverse colon was seen in the CT-scan. Further investigation with a colonoscopy revealed a large polypoid lesion of the left colic angle that involved more than 50% of the bowel lumen. Endoscopic biopsies taken were non-conclusive. Because of the size of the mass and the inability to remove it endoscopically, the patient was operated on with a partial resection of the transverse colon and primary anastomosis. Histopathology demonstrated a lipoma and no signs of malignancy. Postoperative follow-up was completely uneventful and the patient was discharged home 6 days after the intervention in good general conditions.

Conclusion

A colonic lipoma is mostly asymptomatic but may cause bowl habit changes, gastrointestinal bleeding, abdominal pain and pseudo-obstruction, according to its size and location. At colonoscopy, submucosal lipomas are often described, however, a colonic lipoma causing intussusception and therefore obstruction of the large bowel is not reported yet. Larger lipoma may more often be symptomatic, therefore, resection should be considered for those bigger than 20 mm in diameter. If endoscopic removal is not possible a surgical approach with excision by colotomy or segmental resection seems to be the ideal choice of treatment, especially, when malignancy cannot be completely excluded.