Colonic Lipoma : Incidental and Urgent Management , Report of Two Cases and Review of the Literature ”

C l i n M e d International Library Citation: Justo I, Marcacuzco A, Caso O, Cambra F, García-Nebreda M, et al. (2016)“Colonic Lipoma: Incidental and Urgent Management, Report of Two Cases and Review of the Literature”. J Clin Gastroenterol Treat 2:028 Received: April 09, 2016: Accepted: May 27, 2016: Published: May 29, 2016 Copyright: © 2016 Justo I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Justo et al. J Clin Gastroenterol Treat 2016, 2:028


Introduction
Lipomas are benign tumors rarely found in the digestive tract, particularly rare in the colon [1], that were first described by Bauer in 1757 as an unusual cause of intussusception in the adult.Lipomas are most often small, asymptomatic and identified as incidental findings during colonoscopy [2].Nonetheless, up to 25% are symptomatic in the form of abdominal pain, bleeding, diarrhea or intussusception [3].Ninety percent of lipomas in the colon are located at the submucosal layer, with only few originating in the subserosa [4].When lipomas present as bowel obstruction, they are often pedunculated and large [5].

Clinical Case 1
A previously healthy 33-year-old male recently diagnosed by colonoscopy of a colonic submucosal lesion vs extrinsic compression of the hepatic colonic flexure, presented with abdominal pain, diarrhea and rectorrhagia for a month.He complained of worsening symptoms in the previous hours, associated to vomiting.On examination, the patient was afebrile and presented with a distended abdomen that was painful upon deep palpation, but had no signs of rigidity or peritoneal inflammation.Lab work-up showed discrete leukocytosis.

Discussion
Colonic lipomas are rare benign tumors of the digestive tract.Their incidence is estimated between 0.035 and 4.4%, peaking between ages fifty and sixty, with a female preponderance.They are usually solitary and most frequently occur in the ileocecal area [4].
Colonic intussusception is a rare form of presentation for this benign tumor; however, as 64% of neoplasias causing intussisception are malignant, we recommend surgery as the initial approach.The clinical picture of abdominal pain, obstructive symptoms and rectorraghia or melena is unspecific, thus a high index of suspicion is needed for the diagnosis [6], and abdominal CT is the imaging technique with greatest diagnostic yield in these cases.Colonoscopy is useful for locating the injury or evaluating the degree of obstruction, however, since lipomas are usually submucosal injuries, they are very difficult to characterize by this technique alone.Other tests such as abdominal ultrasound or X-ray are less sensitive.Laparoscopy can be therapeutic, but to date there are no defined diagnostic or treatment patterns [7].
Intraoperative frozen section biopsies may be useful for obtaining a faster diagnosis and thus allow more limited resections [8].The laparoscopic removal of these lesions, guided or not by endoscopy, may be very complex in urgent situations [3].
Conservative management and radiological follow-up may be considered in case of an incidental finding of intussusception in the absence of clinical repercussion and with a clear cause; however, in most cases, surgical resection of the affected area allows for the prevention of recurrences of the clinical presentation in the case of benign injuries and a curative treatment in malignant lesions [9].This is especially true in cases requiring urgent intervention.There are reports in the literature of elective endoscopic resections of lesions up to 5 cm, but is not recommended due to the high risk of perforation [10].

Conclusion
Resection of lipomas must be considered in the management of the patients with this pathology who require abdominal surgery.Colo-colonic invagination is a pathology requiring surgical treatment that must be considered in the differential diagnosis of acute intestinal obstruction.