Gastrointestinal lipomas are benign tumors mostly located in the right colon and usually diagnosed during endoscopic procedures [1, 2, 3, 4]. Although typically silent, they can cause symptoms such as bleeding, obstruction, invagination, or prolapse. Their tendency to become symptomatic is strongly correlated with their size and location [1, 2, 3, 4, 5].
We describe the case of a 78-year-old man reporting recurrent abdominal pain in the last 8 months, during which he had an episode of intestinal subocclusion. Colonoscopy revealed an 8-cm yellowish pedunculated lesion at the transverse colon occupying the entire lumen (Fig. 1). The yellowish color and presence of a “pillow sign” supported our presumptive lipoma diagnosis.
Fig. 1.
Endoscopic view of the lipoma occluding the lumen.
As the clinical symptoms reported were thought to be caused by the lipoma, it was decided to perform an endoscopic resection (Video) using a single-channel colonoscope. First, we ligated the stalk with 3 detachable snare loops (Endoloop Olympus) in order to prevent bleeding. Then the lipoma was resected en bloc using a polypectomy snare (Fig. 2, 3). There were no adverse events related to the procedure, which lasted 20 min. The patient was discharged on the same day. Histopathological examination showed a submucosal lipoma with an R0 resection. The patient remains asymptomatic 2 years after resection.
Fig. 2.
Remnant stalk.
Fig. 3.
Resected specimen.
Resection of a gastrointestinal lipoma is recommended for symptomatic lesions. Most authors recommend endoscopic excision exclusively in lipomas of up to 20–30 mm, since larger lesions tend to present an unacceptable rate of complications using an endoscopic approach [2, 4, 5]. However, with the development of new endoscopic devices and techniques such as detachable snare loops, we are now able to remove safely these lesions, which were once referred for surgery [4, 5].
We highlight this case since, as far as we know after literature search, this is one of the largest lipomas resected by endoscopy, underlining the role of interventional endoscopy in the approach of these lesions.
Statement of Ethics
This study did not require informed consent nor review/approval by the appropriate ethics committee.
Disclosure Statement
The authors declare no conflict of interest.
Author Contributions
J.F., R.R., J.C., and L.L. wrote the manuscript. C.V., T.T., and C.C. were responsible for the revision of its contents.
Supplementary Material
Supplemental Video
References
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Supplementary Materials
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