A 4-cm lipoma of the transverse colon causing colonic intussusception: A case report and literature review

Abstract

Colonic lipomas are rare benign tumors. Colonic intussusception is an uncommon complication of colonic lipoma. The current study presents an unusual case of a 4-cm symptomatic lipoma of the transverse colon causing colonic intussusception. A 65-year-old female was admitted to Wenzhou Central Hospital (Wenzhou, Zhejiang, China) with intermittent pain in the left abdomen that had been present for two weeks. Colonoscopy revealed a 4×5-cm intraluminal spherical mass with erosional mucosa 60 cm above the anal verge, indicating the presence of a malignant gastrointestinal stromal tumor. Contrast-enhanced computed tomography revealed a well-defined fatty tissue mass of 4 cm in diameter in the distal transverse colon proximal to the splenic flexure, with intussusception. The patient underwent segmental resection of the transverse colon and intraoperative frozen sections were obtained. The intraoperative frozen sections revealed a submucosal lipoma of the transverse colon and thus, a conclusive diagnosis was achieved. The patient was followed up for one year and 10 months following the segmental resection of the transverse colon, with a good prognosis. This study may increase clinical awareness with regard to colonic lipomas. Furthermore, open surgery combined with use of intraoperative frozen sections should be recommended for large symptomatic colonic lipomas accompanied by colonic intussusception, thus avoiding unnecessary radical resection and improving patient prognosis.

Keywords: colon; diagnosis; intussusception; lipoma.

Figure 1

Colonoscopy image revealing a 4×5-cm intraluminal spherical mass, 60 cm above the anal verge, which prevented further progression of the endoscope. The mass was covered by a 2×3-cm superficial mucosal erosion, indicating the presence of a malignant gastrointestinal stromal tumor.

Figure 2

Contrast-enhanced computed tomography revealing (A) a well-defined fatty tissue mass of 4 cm in diameter (arrow) in the distal transverse colon proximal to the splenic flexure, with (B and C) intussusception (arrow) and local bowel-wall thickening.

Figure 2

Contrast-enhanced computed tomography revealing (A) a well-defined fatty tissue mass of 4 cm in diameter (arrow) in the distal transverse colon proximal to the splenic flexure, with (B and C) intussusception (arrow) and local bowel-wall thickening.

Figure 3

Macroscopic assessment of the resected specimen reveaing the presence of a yellow, round and broader-based 4×4-cm mass with the features of a lipoma.

Figure 4

Histopathological examination of the resected specimen revealing a mass composed of mature fat cells, focal erosion and ulceration of the overlying colonic mucosa (hematoxylin and eosin stain; magnification, ×200).

Figure 5

Histopathological examination of the resected specimen revealing a mass composed of mature fat cells, focal erosion and ulceration of the overlying colonic mucosa (hematoxylin and eosin stain; magnification, ×400).