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Giant colonic lipoma with prolapse through the rectum treated by external local excision: A case report.

Kose E, Cipe G, Demirgan S, Oguz S - Oncol Lett (2014)

Bottom Line: Those that are <2 cm are generally asymptomatic and do not require any treatment.A colonic lipoma must be considered during the differential diagnosis of anorectal diseases, such as hemorrhoids and rectal prolapses.Local excision, hemicolectomy, and segmental and external resection should be considered in addition to an endoscopic polypectomy for the diagnosis and treatment of colonic lipomas.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Büyükcekmece State Hospital, Istanbul 34500, Turkey.

ABSTRACT
Colonic lipomas are a rare type of gastrointestinal benign tumor. Those that are <2 cm are generally asymptomatic and do not require any treatment. However, those that are >2 cm may be symptomatic, resulting in abdominal pain, changes in bowel habits, intestinal obstruction and rectal bleeding. A 39-year-old male patient presented with a mass prolapse through the anal canal, which was causing anal pain and rectal bleeding. The patient was admitted to hospital via the emergency services and directed to the Department of General Surgery with the preliminary diagnosis of a rectal prolapse. A pedunculated polyp (size, 10×8×7.5 cm) was detected at the 35th cm of the anal canal. Due to the large size of the polyp, an endoscopic polypectomy could not be performed. Therefore, the prolapsed lipoma was excised externally and the patient was discharged on the first postoperative day on which no complications were experienced. A colonic lipoma must be considered during the differential diagnosis of anorectal diseases, such as hemorrhoids and rectal prolapses. Local excision, hemicolectomy, and segmental and external resection should be considered in addition to an endoscopic polypectomy for the diagnosis and treatment of colonic lipomas.

No MeSH data available.


Related in: MedlinePlus

Gross lipoma specimen.
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f4-ol-08-03-1377: Gross lipoma specimen.

Mentions: A 39-year-old male patient was admitted to our emergency clinic with a mass protruding from the anal canal. Other symptoms included anal pain and rectal bleeding. During the physical examination, the prolapsed mass was spontaneously reduced through the rectum. The mass was initially diagnosed as a rectal prolapse and the patient was transferred to the Department of General Surgery, Buyukcekmece State Hospital (Istanbul, Turkey) in June 2012. During the physical examination, the mass was forced out from the anal canal while the patient performed the Valsalva maneuver under light sedation. The mass (size, 10×8 cm) had a shiny surface and hyperemia was detected during the physical inspection (Fig. 1). A smooth-surfaced soft tissue with a pedicle (diameter, 3 cm) was detected on palpation. The mass was reduced manually by gentally pushing it through the anus. The routine laboratory examination results were normal and no abnormalities were noted in the patient’s background or family history. A colonoscopy was performed, and at the 35th cm of the anal canal, a mobile, shiny, hyperemic, smooth-surfaced, giant polyp (size, 10×8×7.5 cm), which was covered by a mucosa and a pedicle (diameter, 3 cm) was occluding almost all of the lumen (Fig. 2). At the sigmoid colon, an 8×6-cm fat-density lesion (representing the lipoma) was observed via abdominal computed tomography (CT; Fig. 3). An endoscopic polypectomy was attempted, however, it was unsuccessful due to the size of the lesion measuring ~10 cm in its maximum diameter making it difficult to manipulate the lesion. As a result, an external excision was scheduled. Under light sedation the patient performed the Valsalva maneuver and the mass was forced out from the anal canal. In order to perform an easy removal of the mass from the anus, the pedicle at the exit of the anal canal was tied and the patient’s depth of anesthesia was strengthened. The mass was pulled out, and the distal end of the pedicle was tied and excised. The resected specimen underwent histopathological examination (Fig. 4), which revealed the mass to be a submucosal lipoma with a normal mucosa. The patient was discharged on the first postoperative day on which he did not experience any complications. The colonoscopy, which was performed two weeks later, was considered to be normal.


Giant colonic lipoma with prolapse through the rectum treated by external local excision: A case report.

Kose E, Cipe G, Demirgan S, Oguz S - Oncol Lett (2014)

Gross lipoma specimen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4114596&req=5

f4-ol-08-03-1377: Gross lipoma specimen.
Mentions: A 39-year-old male patient was admitted to our emergency clinic with a mass protruding from the anal canal. Other symptoms included anal pain and rectal bleeding. During the physical examination, the prolapsed mass was spontaneously reduced through the rectum. The mass was initially diagnosed as a rectal prolapse and the patient was transferred to the Department of General Surgery, Buyukcekmece State Hospital (Istanbul, Turkey) in June 2012. During the physical examination, the mass was forced out from the anal canal while the patient performed the Valsalva maneuver under light sedation. The mass (size, 10×8 cm) had a shiny surface and hyperemia was detected during the physical inspection (Fig. 1). A smooth-surfaced soft tissue with a pedicle (diameter, 3 cm) was detected on palpation. The mass was reduced manually by gentally pushing it through the anus. The routine laboratory examination results were normal and no abnormalities were noted in the patient’s background or family history. A colonoscopy was performed, and at the 35th cm of the anal canal, a mobile, shiny, hyperemic, smooth-surfaced, giant polyp (size, 10×8×7.5 cm), which was covered by a mucosa and a pedicle (diameter, 3 cm) was occluding almost all of the lumen (Fig. 2). At the sigmoid colon, an 8×6-cm fat-density lesion (representing the lipoma) was observed via abdominal computed tomography (CT; Fig. 3). An endoscopic polypectomy was attempted, however, it was unsuccessful due to the size of the lesion measuring ~10 cm in its maximum diameter making it difficult to manipulate the lesion. As a result, an external excision was scheduled. Under light sedation the patient performed the Valsalva maneuver and the mass was forced out from the anal canal. In order to perform an easy removal of the mass from the anus, the pedicle at the exit of the anal canal was tied and the patient’s depth of anesthesia was strengthened. The mass was pulled out, and the distal end of the pedicle was tied and excised. The resected specimen underwent histopathological examination (Fig. 4), which revealed the mass to be a submucosal lipoma with a normal mucosa. The patient was discharged on the first postoperative day on which he did not experience any complications. The colonoscopy, which was performed two weeks later, was considered to be normal.

Bottom Line: Those that are <2 cm are generally asymptomatic and do not require any treatment.A colonic lipoma must be considered during the differential diagnosis of anorectal diseases, such as hemorrhoids and rectal prolapses.Local excision, hemicolectomy, and segmental and external resection should be considered in addition to an endoscopic polypectomy for the diagnosis and treatment of colonic lipomas.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Büyükcekmece State Hospital, Istanbul 34500, Turkey.

ABSTRACT
Colonic lipomas are a rare type of gastrointestinal benign tumor. Those that are <2 cm are generally asymptomatic and do not require any treatment. However, those that are >2 cm may be symptomatic, resulting in abdominal pain, changes in bowel habits, intestinal obstruction and rectal bleeding. A 39-year-old male patient presented with a mass prolapse through the anal canal, which was causing anal pain and rectal bleeding. The patient was admitted to hospital via the emergency services and directed to the Department of General Surgery with the preliminary diagnosis of a rectal prolapse. A pedunculated polyp (size, 10×8×7.5 cm) was detected at the 35th cm of the anal canal. Due to the large size of the polyp, an endoscopic polypectomy could not be performed. Therefore, the prolapsed lipoma was excised externally and the patient was discharged on the first postoperative day on which no complications were experienced. A colonic lipoma must be considered during the differential diagnosis of anorectal diseases, such as hemorrhoids and rectal prolapses. Local excision, hemicolectomy, and segmental and external resection should be considered in addition to an endoscopic polypectomy for the diagnosis and treatment of colonic lipomas.

No MeSH data available.


Related in: MedlinePlus