Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection

Abstract

Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old man presenting with hematochezia. Colonoscopy showed a submucosal tumor, about 50 mm in size, in the terminal ileum. A clinical diagnosis of lipoma was established based on the findings of colonoscopy and abdominal computed tomography (CT). As the patient complained of hematochezia and mild iron deficiency anemia associated with repeated tumor prolapse, we decided to remove his lipoma. Consequently, the lesion was completely removed en bloc. Although abdominal CT immediately after removal of the lesion showed a small amount of free air, conservative treatment was successfully carried out for the perforation. Histologically, the removed lesion was a lipoma.

Figure 1

Colonoscopy showing a large pedunculated tumor, 50 mm in size, originating from the ileum end.

Figure 2

Abdominal CT showing a round, smooth and well-demarcated tumor at the end of the ileum (A) with a fat attenuation coefficient of -116 Hounsfield units (arrows) (B).

Figure 3

Whole captured lesion after injection of glycerol at the base of the lesion. The base of the lipoma (A), lacerated muscle layer (B), dissected overlying mucosa and capsule (C), and completely removed lipoma (D).