Sugimoto Kiichi, Sato Koichi, Maekawa Hiroshi, Sakurada Mutsumi, Orita Hajime, Ito Tomoaki, Saita Masayuki, Ikota Masanori, Yoshida Yuko, Yamano Miki
Department of Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
Case Rep Gastroenterol. 2012 May;6(2):557-62. doi: 10.1159/000342350. Epub 2012 Aug 23.
A 77-year-old man presented with repeated episodes of melena. He had a medical history of hypertension, atrial fibrillation and cardiogenic brain infarction and took medications, i.e. an antiplatelet agent. Laboratory data revealed iron deficiency anemia. Colonoscopy revealed a yellowish smooth submucosal tumor, 50 mm in diameter, on the Bauhin valve. The lesion was soft and compressible. The overlying mucosa was erosive. CT scan showed a uniform mass with very low density in the ascending colon, corresponding to the above-detected lesion. The clinical diagnosis of colonic lipoma was established. Using a 25 mm electrocautery snare (Olympus, Tokyo, Japan), we transected the upper portion of the mass to unroof the lesion. The mucosa layer was thick and hard. Fat tissue was observed extruding from the cut surface, consistent with the diagnostic hypothesis. After dissecting the overlying mucosa on the anal side by means of an IT knife (Olympus) in order to completely extrude the mass, the fat tissue was further exposed. It took about 26 min to perform the whole procedure. There were no procedure-related complications. Macroscopically, the resected lesion was a yellow solid tumor, 1.6 × 1.5 × 0.7 cm in diameter. Histopathologic examination of the excised specimen confirmed the diagnosis of a lipoma. The clinical course was uneventful. A follow-up endoscopy 1 month later showed a scarred mucosa at the resection site. Similarly, a follow-up CT scan 2 months later revealed no evidence of residual lipoma. The unroofing technique is safe, easy and suitable for the treatment of large lipomas.
一名77岁男性出现反复黑便症状。他有高血压、心房颤动和心源性脑梗死病史，正在服用抗血小板药物。实验室检查显示缺铁性贫血。结肠镜检查发现回盲瓣处有一个直径50毫米的淡黄色光滑黏膜下肿瘤。病变质地柔软，可压缩。覆盖其上的黏膜有糜烂。CT扫描显示升结肠有一个密度极低的均匀肿块，与上述检测到的病变相对应。确诊为结肠脂肪瘤。我们使用25毫米电凝圈套器（日本东京奥林巴斯公司）横断肿块上部以暴露病变。黏膜层厚且硬。从切面观察到有脂肪组织挤出，与诊断假设相符。为了完全挤出肿块，用IT刀（奥林巴斯公司）在肛门侧切开覆盖的黏膜，进一步暴露脂肪组织。整个操作过程耗时约26分钟。未出现与操作相关的并发症。肉眼可见，切除的病变为黄色实性肿瘤，直径1.6×1.5×0.7厘米。切除标本的组织病理学检查确诊为脂肪瘤。临床过程平稳。1个月后的随访内镜检查显示切除部位黏膜有瘢痕形成。同样，2个月后的随访CT扫描未发现残留脂肪瘤的迹象。去顶技术安全、简便，适用于治疗较大的脂肪瘤。
