Aim: Colonic lipomas (CL) are generally asymptomatic and are found incidentally during colonoscopy, colonography or surgery for other conditions. Symptoms often correlate with the size of the lipoma; lipomas larger than 4 cm in size become symptomatic in 75% of patients and they are described as Giant typed twice colonic lipoma (GCL). GCL may cause bleeding, obstruction, mimic large polyps, and can create a diagnostic dilemma. We review the clinical management of a series of four GCL patients.
Method: Following a series of unusual presentations and management of patients with GCL; we decided to review CT colonography performed for patients not unsuitable and or unable to complete colonoscopy over a 4-year period. Furthermore, we described the clinical presentations and management outcomes from the 4-case series.
Results: A total of 3775 CT colonograph were performed between Jan 2011 – Dec 2015, with 174 (4.6%) cases of reported CL, of which 0.002% were identified as GCL. 116 CL patients were females (66%), with a mean age of 77 years. With more than 80% located in the right colon. From the case series analysed; four patients had GCL. Two patients presented as acute large bowel obstruction secondary to colonic intussusception on CT scan. Both required emergency hemi-colectomies. The other two presented with changes in bowel habit. One required an elective laparoscopic colotomy and the other was resected endoscopically.
Conclusion: CL can be confidently diagnosed on CT colonography and do not require any specialised imaging or endoscopic assessment for histologically purposes. Endoscopic removal of GCL is feasible and can be performed safely when the right skill set, and experience is available. However, surgical resection remains the main stay treatment for obstructive GCL.