Use of simple endoscopic ligation to successfully remove a large torsional colonic lipoma causing intussusception

Colonic lipomas are uncommon benign submucosal tumors that are usually asymptomatic. However, some lipomas >4 cm may cause intussusception, abdominal pain, or hematochezia [1]. Most patients with giant lipomas require surgery for relief of symptoms [2]. Recently, endoscopic mucosal resection, endoscopic mucosal resection after precutting, and endoscopic submucosal dissection have been reported for the treatment of large lipomas [3]. However, the fatty tissue is an inefficient conductor of electronic current and may lead to a high incidence of complications [4]. We report the use of endoscopic ligation for the treatment of a large, torsional, colonic lipoma causing intussusception.

A 40-year-old man complained of abdominal pain and hematochezia. Colonoscopy found a huge submucosal mass ([Fig. 1] a), which was considered to be lipoma with adjacent colonic intussusception by computed tomography (CT) ([Fig. 1] b).

Fig. 1 Initial examination. a Endoscopic image. b Computed tomography image.

Owing to the torsion of the muscularis mucosae and lamina propria layers of the broad lipoma pedicle ([Fig. 2] a), which could not be resolved by submucosal injection, endoscopic submucosal dissection carried a high risk of perforation. Ultimately, we decided to employ endoscopic ligation.

Fig. 2 Endoscopic treatment. a Torsion of the broad lipoma pedicle. b Lipoma after ligation.

First, the nylon loop was gradually tightened and released to ligate the base of the lipoma. The lipoma turned dark purple within 2 minutes ([Fig. 2] b). Six days later, the lipoma detached and embedded in the colon, 20 cm from the anus, and was difficult to remove. On the seventh day, the mass was found in the patient’s stool ([Fig. 3]) and was confirmed to be a lipoma by histopathology examination, with size 6.5×3.7×3.1 cm. Colonoscopy showed a large ulcer with neat margins and light yellow plaque ([Video 1]).

Fig. 3 The discharged lipoma.

Use of simple endoscopic ligation to successfully remove a large, torsional, colonic lipoma causing intussusception.Video 1

This case demonstrates the efficacy and safety of endoscopic ligation for giant, torsional, colonic lipoma with broad pedicle. We also thoroughly tracked the patient’s postoperative symptoms ([Fig. 4]), which provides a reference for similar patients in the future.

Fig. 4 The patient’s postoperative symptoms.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Zhang H, Cong JC, Chen CS. et al. Submucous colon lipoma: a case report and review of the literature. World J Gastroenterol 2005; 11: 3167-3169
• 2 Gould DJ, Anne Morrison C, Liscum KR. et al. A lipoma of the transverse colon causing intermittent obstruction: a rare cause for surgical intervention. Gastroenterol Hepatol 2011; 7: 487-490
• 3 Lee KJ, Kim GH, Park DY. et al. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 2014; 28: 185-192
• 4 Raju GS, Gomez G. Endoloop ligation of a large colonic lipoma: a novel technique. Gastrointest Endosc 2005; 62: 988-990

Publication History

Article published online:
03 November 2023