The dramatic presentation of colonic lipomata: Report of two cases and review of the literature

Colonic lipoma with a dramatic presentation requiring urgent operation is a rare occurrence. We report two such cases in conjunction with a review of the literature on colonic lipomata. Clinicopathologic features of two patie nts who required urgent resection were studied. The preoperative diagnosis of colonic lipoma was suggested on imaging study in one case. A MEDLINE sea rch was conducted with a special goal of revealing cases with a dramatic pr esentation. One patient presented with rectal bleeding and intussusception related to a partially infarcted 4.5-cm submucosal lipoma of the lower desc ending colon. The second patient presented with intestinal obstruction rela ted to a near-totally infarcted 6-cm submucosal lipoma at the splenic flexu re. In both cases a florid reactive vascular and fibro-/myofibroblastic pro liferation and associated hyperplastic mucosal pattern were present at the base and edge of the lipoma. Among 275 previously reported cases of colonic lipoma 28 patients had a dramatic presentation with pain and/or rectal ble eding being the most significant prodromal symptom. In this subset the lipo mas tended to be larger, frequently had associated marked necrosis/ulcerati on, and were less likely to be located in the ascending colon/cecum. Wherea s colonic lipomas are relatively common occasional cases present dramatical ly with massive bleeding, intussusception, or even perforation for which em ergency operation is required. Such lipomas usually reveal marked ischemic changes.