A Rare Case of a Large Duodenal Lipoma Resulting In Intussusception and Gastric Outlet Obstruction

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Duodenal lipomas are uncommon benign lesions containing fat cells, and the vast majority of cases are asymptomatic. Larger lesions can result in abdominal pain, gastrointestinal bleeding, and obstruction1. Here, we report a rare case of a large duodenal lipoma that had resulted in intussusception and gastric outlet obstruction. Case Description/Methods: A 45-year-old man with progressive symptoms of poor oral intake, nausea, vomiting, and early satiety for a few months was referred to our center for further evaluation of a large submucosal lesion found on recent esophagogastroduodenoscopy (EGD). Repeat EGD revealed a large lesion protruding through the pylorus and extending into the duodenum to the level of the major papilla resulting in duodenal obstruction (Figure 1A). The length of this lesion was at least 6-7cm, and the stalk/base was wide (4-5cm). The major papilla was not involved. The patient was referred to surgical oncology outpatient, however he presented 1 month after initial endoscopy with gastrointestinal bleeding. Repeat EGD revealed the same gastroduodenal lesion with a small superficial ulcerated area and evidence of old blood. Bleeding resolved spontaneously, so no endoscopic treatment was performed. Given worsening symptoms of obstruction and bleeding, patient was evaluated for earlier surgery. He underwent distal gastrectomy with duodenal resection and Roux-en-Y gastrojejunostomy. He tolerated the procedure well and was discharged 6 days post-operatively with a full liquid diet. Surgical pathology (Figure 1B) revealed a submucosal lipoma with fat necrosis (9.4 cm in greatest dimension) and no evidence of dysplasia or malignancy. Discussion: We present this case to highlight an extremely rare presentation of a large duodenal lipoma resulting in bleeding, intussusception, and gastric outlet obstruction. Initial diagnosis can be made with cross-sectional imaging, endoscopy, and/or endoscopic ultrasound. Although there are no clear guidelines for management of these lesions, endoscopic excision is usually favorable. However, for larger lesions, surgical excision may be the more optimal approach. Endoscopists should be aware of the endoscopic/endosonographic features, locations, and unique clinical presentations of these rare lesions.

Volume

119

Issue

10

First Page

S3027

Last Page

S3028

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