[Intestinal occlusion due to a colonic lipoma. Apropos 2 cases]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• Lipomas are the most common benign nonepithelial tumors of the colon, typically found in the submucosal plane.
• While generally asymptomatic, colonic lipomas can cause symptoms like abdominal pain and rectal bleeding, particularly when large or pedunculated.
• The peak incidence of large bowel lipomas occurs in the fifth and sixth decades of life.

Observation:

• Two cases of symptomatic colonic lipomas are presented: one in the transverse colon causing obstruction in a 68-year-old male, and another in the descending colon presenting as a rectal polyp with bleeding in a 65-year-old male.
• Radiological findings suggestive of lipoma include well-demarcated, radiolucent masses on barium enema, with the "squeeze sign" being a characteristic feature.
• Colonoscopy and computed tomography (CT) scans can also aid in the diagnosis of colonic lipomas.

Findings:

• Histological examination confirmed submucosal lipomas in both reported cases.
• Surgical intervention, including hemicolectomy, was performed in both cases due to obstructive symptoms or prolapse.
• Preoperative differentiation between benign lipomas and malignant colonic neoplasms remains difficult.

Implications:

• Colonic lipomas, though uncommon, pose diagnostic challenges and can mimic malignant tumors, necessitating careful evaluation.
• Despite advancements in imaging, exploratory laparotomy is often employed for presumptive malignant diagnoses.
• Improved diagnostic accuracy is crucial for appropriate management and avoiding unnecessary surgeries.