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      Laparoscopic segmental resection of the rectum for upper rectal intussusception caused by a giant rectal lipoma : A case report

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          Abstract

          Rationale:

          Colonic lipomas are rare benign tumours, usually without any symptoms, and most occur in the caecum and ascending colon. We describe a patient with upper rectal intussusception caused by a giant rectal lipoma; no similar report of this type of case has been published.

          Patient concerns:

          We report the case of a patient who suffered from repeated bloody stools. A wide pedicle polyp (size, 6.5 × 4.5 × 3.5 cm) was detected at the 15th centimetre of the anal canal via an electronic colonoscope. At the initial part of the rectum, intussusception caused by a 6.5-cm fat-density mass was observed via abdominal contrast-enhanced computed tomography.

          Diagnosis:

          Upper rectal intussusception caused by a giant rectal lipoma.

          Interventions:

          Due to the large size of the polyp, an endoscopic polypectomy could not be performed. We performed laparoscopic segmental resection of the rectum (with preservation of the left colic artery [LCA]).

          Outcomes:

          The patient was discharged on the 7th postoperative day without any complications, was monitored on a regular basis at our outpatient department and was free of symptoms at a 3-month follow-up visit.

          Lessons:

          Laparoscopic segmental resection of the rectum with LCA preservation is safe and feasible for the treatment of upper rectal intussusception caused by a giant rectal lipoma.

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          Most cited references18

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          Giant submucosal lipoma located in the descending colon: a case report and review of the literature.

          Colonic lipoma is an uncommon tumor of the gastrointestinal tract. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, we encountered one patient with a giant submucosal lipoma, with a maximum diameter of 8.5 cm, which exhibited symptoms such as intermittent lower abdominal pain, changes in bowel habits with passage of fresh blood and mucus per rectum, abdominal distension, anorexia and weight loss. Unfortunately, the possibility of colonic malignancy could not be precluded and left hemicolectomy was planned. The exact diagnosis of this special case was accomplished by intraoperative pathology. In the end, local resection was performed instead of left hemicolectomy. To the best of our knowledge, colonic lipoma exceeding 8 cm in diameter has not been previously reported. We, therefore, present this case and discuss age and sex factors, clinical and histopathological findings, diagnostic methods and treatment by reviewing the available literature, to serve as a reminder that colonic lipoma can also exist in patients with significant symptoms. In addition, intraoperative pathology should be investigated in those doubtful cases, so as to guide the exact diagnosis and treatment plan.
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            • Record: found
            • Abstract: not found
            • Article: not found

            Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: A meta-analysis

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              • Record: found
              • Abstract: found
              • Article: not found

              Endoscopic removal of large colonic lipomas.

              Colonic lipomas are benign adipose tumors that rarely cause symptoms. Removal of lipomas 2 cm or greater in diameter has been associated with a greater risk of perforation. Experience with the evaluation and removal of large colonic lipomas with the assistance of EUS to reduce the risk of perforation is reported. Four patients with large colonic lipomas were evaluated and treated with endoscopic methods. EUS was performed to confirm that the lesion was a lipoma superficial to the muscularis propria. Saline or epinephrine solution was injected at the base of the tumor, which was then resected electrosurgically with a snare. All 4 lesions were successfully removed and histopathologically confirmed to be lipomas (mean maximal diameter 2.8 cm). There were no complications of any procedure. One patient was hospitalized overnight because of abdominal pain that resolved without complication. Large colonic lipomas can be removed safely by electrosurgical snare resection after injection of the base with epinephrine or saline solution. EUS should be used to ensure that the lipoma does not extend into the muscularis propria. Clinical judgment is important in assessing the need to remove these lesions.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                September 2018
                28 September 2018
                : 97
                : 39
                : e12272
                Affiliations
                [a ]Department of General Surgery, The Second Affiliated Hospital of Nanchang University
                [b ]The First Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China.
                Author notes
                []Correspondence: Shengxun Mao, Department of General Surgery, The Second Affiliated Hospital of Nanchang University (e-mail: maoshengxun@ 123456126.com ).
                Article
                MD-D-18-03005 12272
                10.1097/MD.0000000000012272
                6181545
                30278497
                e7223914-87f9-467e-bfa5-998284412b2a
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 2 May 2018
                : 16 August 2018
                Categories
                7100
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                giant rectal lipoma,laparoscopic segmental resection,left colic artery,rectal intussusception

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