Laparoscopic management of large colonic lipoma with atypical presentation: A case report

TL;DR

A case report describes successful laparoscopic removal of a large colonic lipoma causing abdominal pain and urinary urgency.

Contribution

Demonstrates a successful laparoscopic approach for a large colonic lipoma with a novel use of methylene blue dye for surgical guidance.

Findings

Laparoscopic excision of an 80% obstructive colonic lipoma was successfully performed with minimal postoperative recovery.

Methylene blue dye was used to mark the base of the mass preoperatively, aiding in precise excision.

Computed tomography and colonoscopy were used together to confirm the diagnosis and plan treatment.

Abstract

Colonic lipomas (CL) are a rare condition that typically causes symptoms in only a minority of patients. When large lipomas occur, they often necessitate extensive surgery, which carries significant risks.

We present a case of a female patient who experienced abdominal pain and urinary urgency due to a large, 80 % obstructive lipoma in the descending colon. On abdominal Computed tomography scan, a 3.8 cm lesion with fatty density and no solid components was identified. Given its benign nature, our approach aimed to preserve the colon. This involved performing laparoscopic excision of the lipoma after marking the base of the mass with a methylene blue dye few hours prior to surgery. The patient recovered well postoperatively, with an excellent outcome, and was discharged home on the third day after surgery.

Colonic lipomas are a rare finding in the gastro-intestinal tract, they are benign in nature and can cause a variety of symptoms. The diagnostic pathway can be challenging due to the broad presentation and the variable onset of symptoms. Using multiple imaging modalities (invasive and non-invasive methods) can help narrow down the diagnosis and facilitate the treatment course.

Our review of literature indicated that Descending Colon lipoma is rare. With nonspecific symptoms imaging modalities such as computed tomography was used in conjunction with Colonoscopy to further delineate origin and pathology. The treatment depends on the patient's condition as well as the size and position of the tumor.

•Colonic lipomas are a rare condition that occurs in a minority of patients.•Clinical findings have a wide variety of presentations and onsets.•Using multiple invasive and non-invasive imaging modalities can help in the diagnosis and management.•The treatment plan depends on the size of the lipoma and the condition of the patient

Colonic lipomas are a rare condition that occurs in a minority of patients.

Clinical findings have a wide variety of presentations and onsets.

Using multiple invasive and non-invasive imaging modalities can help in the diagnosis and management.

The treatment plan depends on the size of the lipoma and the condition of the patient

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