Large colonic lipomas presenting as a rare cause of adult bowel obstruction and intussusception: A two-case surgical series

Abstract

Introduction and importance

Colonic lipomas are uncommon benign tumors of mesenchymal origin that are typically asymptomatic but can lead to significant complications, including bowel obstruction or intussusception, when they grow large.

Presentation of case

We report two cases of symptomatic colonic lipomas presenting with features of intussusception and bowel obstruction. The first case involved a 70-year-old male with chronic abdominal pain, hematochezia, and obstructive symptoms, in whom colonoscopy and CT imaging revealed a large lipoma of the ascending colon causing ileocolic intussusception. The second case was a 36-year-old male presenting with acute lower abdominal pain, and imaging demonstrated a transverse colon lipoma with signs of partial obstruction and intussusception. Both patients underwent laparotomy with segmental colectomy and primary anastomosis. Histopathological examination confirmed benign submucosal lipomas. Postoperative courses were uneventful, with complete resolution of symptoms.

Discussion

Colonic lipomas are frequently asymptomatic but may lead to intussusception, with symptoms influenced by their size and location. The increased use of CT imaging has improved preoperative diagnosis. Management ranges from observation to endoscopic or surgical resection. However, selecting the optimal surgical approach remains challenging due to overlapping features with malignant lesions and the risk of complications in large or symptomatic cases.

Conclusion

Although uncommon, colonic lipomas should be considered in the differential diagnosis of adult intestinal obstruction. Imaging plays a key role, and surgical resection remains the definitive management for symptomatic cases.