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iant Colonic Lipoma Presenting as Intermittent ObstructionHREE J. KRISHNAN,* THOMAS M. SHEHAB,*,‡ and STANLEY R. STRASIUS‡

Department of Internal Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan; and ‡Huron Gastroenterology Associates, Center for

igestive Care, Ann Arbor, Michigan

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36-year-old woman presented with 4 distinct episodes of severeabdominal pain, progressive abdominal distention, nausea, and

n 3 occasions, vomiting: 2 with lack of flatus and the last with bloodyiarrhea over a 6-month period. She had an unintentional weight lossf 7 pounds during this period. Physical examination was unremark-ble. Routine blood work results were normal. Barium enema showed persistent 4.5-cm filling defect within the descending colon (Figure). The mass was somewhat mobile, pedunculated, and smooth. Aolonoscopy was performed that showed a 4.5-cm circular mass thatearly obstructed the lumen of the colon (Figure B). There was super-cial mucosal necrosis and chronic inflammation. Biopsy specimenshowed a colonic ulcer negative for neoplasm. The patient underwentleft hemicolectomy and the surgical specimen contained a peduncu-

ated, well-circumscribed mass appearing to arise from the mucosa.icroscopic examination showed extensive submucosal adipose tissue

nd mucosal ulceration. The findings were consistent with a lipomaith mucosal ischemia. The specimen was negative for malignancy.he patient is now symptom free 1 year after surgery.Lipomas are the most common benign nonepithelial neoplasm of the

olon.1 Colon lipomas account for more than 60% of all gastrointestinalract lipomas and are present in .3%–.9% of patients at the time ofndoscopy. They are most common in the right colon and more than 90%rise in the submucosa. Endoscopically, lipomas usually are smooth,ounded lesions that are more yellow than the surrounding mucosa. Theyypically are wide based but can be pedunculated. Forceps biopsy exam-nation on the surface of a lipoma often discloses yellow adipose tissue.

Lipomas rarely are symptomatic but can cause symptoms as theynlarge. Lipomas greater than 2 cm can cause obstruction, intussus-

eption, or, rarely, bleed from mucosal ischemia. When colonic lipo-

as become symptomatic they require resection. There is debate inhe literature regarding the safety of endoscopic removal of symptom-tic colonic lipomas.2,3 Unlike hyperplastic and adenomatous polyps,hich are mucosal and can be removed with low rates of perforation,

ipomas begin in the deeper submucosal layers. In addition, peduncu-ated lipomas may have complicated stalks containing muscularis pro-ria or serosal tissues predisposing to perforation at the time of endo-copic resection. Although there are case reports of large colonicipomas successfully being removed endoscopically, most symptom-tic lipomas are likely to require surgical intervention.

Colonic lipomas typically are incidental findings, but larger lipomasan cause symptoms of obstruction. Large colonic lipomas should beonsidered in the differential diagnosis of young patients with alarmymptoms.

References. De Beer RA, Shinya H. Colonic lipomas. An endoscopic analysis.

Gastrointest Endosc 1975;22:90–91.. Bar-Meir S, Halla A, Baratz M. Endoscopic removal of colonic

lipoma. Endoscopy 1981;13:135–136.. Tamura S, Yokoyama Y, Morita T, et al. “Giant” colon lipoma: what

kind of findings are necessary for the indication of endoscopicresection? Am J Gastroenterol 2001;96:1944–1946.

© 2006 by the American Gastroenterological Association Institute1542-3565/06/$32.00

PII: 10.1053/S1542-3565(05)00863-3

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:xxv