Introduction- Lipomas of the colon and rectum are rare GI neoplasms, though they are the second most common benign tumors after adenomatous polyps.  Rectal lipomas are even rarer, constituting only 5% of the total GI lipomas. About 90% cases arise from the sub mucosa, with the remaining 10% being subserosal or intramuscular.The clinical manifestations of this disease lack specificity, and some physicians lack understanding and experience, making it prone to misdiagnosis. They are usually asymptomatic and are found incidentally during colonoscopy screening or other imaging modalities. However, if enlarged enough, they can present with obstruction symptoms, abdominal pain, and ulceration..

Aim and Objectives – To present a case of rectal lipomatosis with rare clinical presentation.

Methods – A 64 year old female patient presented to the surgical outpatient department with a two-month history of bleeding per rectum. Clinical examination led to a diagnosis of rectal prolapse. The prolapsed segment, along with a portion of the sigmoid colon, was excised for histopathological examination.

Gross Findings:
The excised specimen consisted of a 12.5 cm segment of rectum and sigmoid colon. The cut surface of the specimen showed a thickened and yellowish submucosa

Representative tissue sections were processed, stained with hematoxylin and eosin  and examined by two independent pathologists for confirmation

Result - Histomorphological features are consistent with Rectal submucosal lipomatosis

Conclusion - Rectal submucosal lipomas can present clinically as rectal prolapse, leading to a diagnostic challenge. In this case, the atypical presentation was clarified through histopathological examination, emphasizing the importance of biopsy in cases with unusual features. Early diagnosis and surgical excision of symptomatic cases can help avoid complications and ensure successful management.

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