A Large Sigmoid Pseudo-Pedunculated Lipoma Mimicking an Adenoma: A Report of a Rare Case and Literature Review

Large colonic lipomas exceeding 2.0 cm in size may rarely mimic colorectal adenomas and hence we referred to such lipomas as pseudo-pedunculated lipomas. They can exhibit surface erosions, fissure ulcerations, and mucosal erythema and can pose diagnostic dilemmas during colonoscopy. Our patient presented with iron deficiency anaemia and a positive faecal immunochemical test, a rare but recognised presentation of pseudo-pedunculated lipomas. Available advanced and refined procedures made endoscopic removal of large and even giant, symptomatic, pedunculated lipomas safe and should be the standard of care, while surgical intervention is rarely necessary. Nonetheless, utmost care must be exercised during endoscopic resection due to the high current needed to snare such large lesions to avoid deep thermal injury and perforation. Our case showed that large lipomas can be misinterpreted during endoscopy as adenomas. In experienced hands, endoscopic removal is safe and attainable.