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Case Reports
, 10 (3), 538-544
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Two Patients With Large Colonic Lipomas for Which Endoscopic Unroofing Was Ineffective

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Case Reports

Two Patients With Large Colonic Lipomas for Which Endoscopic Unroofing Was Ineffective

Yuichi Tomiki et al. Case Rep Gastroenterol.

Abstract

Endoscopic unroofing is effective for treating large colonic lipomas. However, additional endoscopic resection is occasionally required when the outcomes of initial unroofing are incomplete. The colonoscopy of an 82-year-old woman with abdominal pain revealed a yellowish lipoma of about 20 mm in the transverse colon. The mass was treated by unroofing, but a follow-up colonoscopy 5 days later revealed residual lipoma. One month later, the regenerated surface had become covered with mucosa, and the status of the lipoma had returned to that before unroofing. The colonoscopy of a 74-year-old man with abdominal pain and melena revealed a 50-mm-wide protruding lipoma in the transverse colon. The mucosa of the upper third of the lipoma was excised using an electric knife and snare, which allowed the immediate partial drainage of adipose tissue. Unroofing proceeded, but 7 days later, the unroofed surface had become coated with a white substance, and the residual lipoma required additional endoscopic resection. Colonic lipomas are often asymptomatic. However, patients with abdominal pain and hemorrhage should be treated in consideration of complete resection, but not by unroofing, which could leave a residual tumor. Drainage should be confirmed after unroofing and any residual lipoma should be treated by additional resection.

Keywords: Colonic lipoma; Endoscopic submucosal dissection; Endoscopic treatment; Endoscopic unroofing.

Figures

Fig. 1
Fig. 1
Colonoscopy findings of lipoma in an 82-year-old woman. a A smooth, yellowish submucosal tumor of about 20 mm in the transverse colon. b The upper third of lipoma body was excised using a snare. c The unroofed surface was open, but the lipoma persisted for 5 days. d The lipoma was covered with regenerated mucosa at 1 month after unroofing.
Fig. 2
Fig. 2
Colonoscopy findings of lipoma in a 74-year-old man. a A protruding mass with a 50-mm-wide base and thickened, erosive mucosa in the transverse colon. b Mucosa of the upper third of lipoma after circumferential incision using an electric knife. c The upper third of lipoma body excised using a snare. d Adipose material extrudes from the cut surface.
Fig. 3
Fig. 3
Colonoscopy findings of lipoma in a 74-year-old man at 1 week after unroofing and 4 weeks after piecemeal EMR. a The unroofed surface was coated with white substance, and the residual lipoma was evident after 1 week. b, c The lipoma was removed by piecemeal EMR. d Four weeks thereafter, the resected region was cicatrized without residual lipoma.

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