Antonio M. Lacy (Director of Gastrointestinal Surgery Department)
Ainitze Ibarzábal (Gastrointestinal Surgery Senior Specialist)
Mario Pagès (Radiology Consultor)
Hospital Clínic, Barcelona, Spain
A 49-year-old male with a previous history of HBP and cholecystectomy presented with intermittent abdominal pain and rectal bleeding. The general practitioner ordered a colonoscopy that revealed a large polypoid lesion 50cm from the anal verge (FIG. 1). The patient was referred to the emergency room as the lesion occupied the entire colonic lumen.
In the physical examination the abdomen was found to be slightly distended. Clinical and laboratory tests revealed no sepsis. The patient was admitted to continue with the study, and a CT scan was ordered, which found a 5.5 x 3 cm lipoma at the sigmoid colon that was causing a colonic intussusception into the rectosigmoid junction (FIG. 2).
A laparoscopic surgical resection was carried out. The tumor was producing severe inflammatory changes in the colon and collateral vascularization. Oncological dissection was performed with ligation of the IMV at the origin.
Medial to lateral mobilization was accomplished, and the left ureter and gonadal vessels were respected. Subsequent lateral detachment was performed until a macroscopic healthy tissue was identified.
The distal margin was sectioned using Blue EndoGIATM. The specimen was extracted through an auxiliary incision, covered with a wound protector, and the proximal margin was sectioned using mechanical sutures.
The surgeon decided to create a colostomy and perform delayed colorectal anastomosis due to the precarious local characteristics of the rectal stump.
Surgerywas accomplished in 110 minutes with no conversion to an open approach. The patient started oral intake the second postoperative day and left hospital on the 5th day after the procedure.
Pathological examination revealed 5.2 x 3.5 x 2.8cm lipoma with an ulcerated center. 16 lymph nodes were harvested (all of which were negative).
He underwent an uneventful Hartmann’s reversal 4 months later (having a normal colonoscopy and water soluble enema). No late complications were diagnosed in the most recent follow up.