A rare complication of endoscopic ligation (“loop-and-let-go”) for management of a giant colonic lipoma

A 65-year-old man presented with a 6-month history of intermittent lower gastrointestinal bleeding and lower abdominal pain. Colonoscopy revealed a soft, yellowish submucosal tumor measuring around 10 cm with a short, wide pedicle in the transverse colon ([Fig. 1 a]). Endoscopic ultrasonography showed a hyperechoic lesion originating from the submucosal layer ([Fig. 1 b]). As the endoscopic signs were compatible with a colonic lipoma, we performed endoscopic ligation (“loop-and-let-go”) to treat the giant lipoma ([Fig. 1 c]). The symptoms of bleeding and abdominal pain were relieved. Unfortunately, on the 15th day after the procedure the patient suffered from severe lower abdominal pain and vomiting. Emergency colonoscopy showed that the shedding tumor was contributing to rectal occlusion ([Fig. 1 d]), and it was removed from the rectum using oval forceps ([Fig. 1 e]; [Video 1]).

Fig. 1 a A soft, yellowish giant submucosal tumor in the transverse colon; b a hyperechoic lesion originating from the submucosal layer; c endoscopic ligation (“loop-and-let-go”) to treat the giant lipoma; d the shedding tumor obstructing the rectum; e the shed tumor.

Video 1 Removing the shedding tumor from the rectum using oval forceps.

Colonic lipomas are uncommon benign gastrointestinal subepithelial tumors, with a reported prevalence of 0.3 % [1]. Most colonic lipomas are usually asymptomatic and detected incidentally during colonoscopy. When colonic lipomas become larger or symptomatic, they should be removed [2]. A prospective study demonstrated that the “loop-and-let-go” technique is feasible and safe for removal of giant colonic lipomas (ranging in size from 2 cm to 6 cm) because it avoids electrocautery and eliminates the risk of bleeding and perforation [3]. However, in the present case this technique was performed to remove a colonic lipoma as large as 10 cm, and in this patient the shedding tumor contributed to rectal occlusion. We offer this reminder of this possible complication of rectal occlusion when the “loop-and-let-go” technique is employed to remove a giant colonic lipoma.

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Competing interests

The authors declare that they have no conflict of interest.

^* These authors contributed equally to this work.

• References

• 1 Mantzoros I, Raptis D, Pramateftakis MG. et al. Colonic lipomas: our experience in diagnosis and treatment. Tech Coloproctol 2011; 15: S71-S73
• 2 Nallamothu G, Adler DG. Large colonic lipomas. Gastroenterol Hepatol 2011; 7: 490-492
• 3 Ivekovic H, Rustemovic N, Brkic T. et al. Endoscopic ligation (“loop-and-let-go”) is effective treatment for large colonic lipomas: a prospective validation study. BMC Gastroenterol 2014; 14: 122-126

Publication History

Article published online:
19 July 2021