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1
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Almeida ML, Costa M, Bezerra Regueira T, Prince Franzini T, Secchi TF, Oliveira RF, Ferreira ALO, Carpanetti I. Ulcerated Jejunal Lipoma Causing Gastrointestinal Bleeding: A Case Report. Cureus 2024; 16:e73446. [PMID: 39669820 PMCID: PMC11634554 DOI: 10.7759/cureus.73446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2024] [Indexed: 12/14/2024] Open
Abstract
Lipomas of the small intestine are rare and generally asymptomatic. However, they can present with obstructive symptoms or gastrointestinal bleeding that is difficult to localize. A 63-year-old female patient was admitted to the emergency department with a complaint of melena for four days. Endoscopy and colonoscopy were performed without any abnormalities. The patient showed no further externalization of symptoms and had a suspicion of intussusception on a CT scan. A capsule endoscopy was performed, revealing an elevated and ulcerated lesion in the proximal jejunum near the Treitz angle. An attempt at enteroscopy was made, but it was suspended due to gastric stasis. The patient developed obstructive symptoms and underwent exploratory laparotomy, which required enterectomy. The histopathological examination confirmed that the lesion was an ulcerated lipoma. Lipomas of the small intestine are rare and challenging to diagnose. The use of capsule endoscopy and enteroscopy allows for the diagnosis of these lesions, greater accuracy in localization, and, in some cases, treatment.
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Affiliation(s)
| | - Marcus Costa
- Gastrointestinal Endoscopy, Hospital Nove de Julho, São Paulo, BRA
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2
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Sahni M, Daga R, Jangir N, Singh S, Sharma R. Management of a Rare Challenging Case of Duodenal Ampullary Lipoma. Indian J Surg Oncol 2024; 15:322-324. [PMID: 38817998 PMCID: PMC11133299 DOI: 10.1007/s13193-023-01857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/29/2023] [Indexed: 06/01/2024] Open
Abstract
Duodenal lipoma is a very rare entity with limited case reports present in literature. But duodenal ampullary lipomas are even more rare in nature. Owing to the recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, challenge lies in performing a less invasive and least morbid procedures to treat them surgically in such complex location of tumour. To study the diagnosis and treatment of duodenal ampullary lipoma in a young male patient and challenges faced during surgical management. A 15-year-old young boy presented to us with complaints of intermittent upper gastrointestinal bleed and jaundice since last 2 months. At admission, his serum haemoglobin was 3 g% for which he was transfused 3 units of packed blood cells for optimization. On further evaluation, CT scan abdomen revealed 71 × 49 mm large heterogeneous mass in D3 segment of duodenum causing duodeno-duodenal intussusception involving D1 and D2 segment along with ampullary region with mass being the lead point. There was compression of CBD with dilatation measuring 11 mm in diameter and mild IHBR dilatation. UGIE revealed narrowing at D1-D2 junction due to polypoidal lesion with overlying smooth mucosa with no active bleeding point identified. His blood parameters were normal except for low haemoglobin (before blood transfusion) and total serum bilirubin of 2.3 mg/dl.He was optimized for surgery and underwent exploratory laparotomy with duodenotomy at D2 with mass excision of 7 × 5 cm sessile polyp with base over ampulla followed by plastic repair of sphincter of Oddi (pancreas preserving procedure). He was started on oral liquids on POD 3 and was discharged on normal diet by POD 7 with an uneventful recovery. Result of histopathological report revealed, on gross cut section, the presence of mass of 7 × 5 × 3 cm size with smooth mucosa and fibrofatty tissue. On microscopic examination, diagnosis of submucosal lipomatous polyp was made. Our case report indicated duodenal ampullary lipoma is extremely rare entity. The symptoms are nonspecific and CT scan abdomen is the first investigation of choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour. In our case report, the tumour base was exactly at the level of ampulla where we performed complex procedure of local excision of mass with sphincteroplasty avoiding major Whipple procedure for such benign condition. It provided rapid postoperative recovery to the patient.
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Affiliation(s)
- Manish Sahni
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Ram Daga
- Department of Surgical Gastroenterology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Nishant Jangir
- Department of Surgical Gastroenterology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan India
| | - Rajgovind Sharma
- Department of Surgical Oncology, M.G. Medical College and Hospital, Jaipur, Rajasthan India
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3
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Nguyen LC, Vu KT, Vo TTT, Trinh CH, Do TD, Pham NTV, Pham TV, Nguyen TT, Nguyen HC, Byeon JS. Brunner’s gland hyperplasia associated with lipomatous pseudohypertrophy of the pancreas presenting with gastrointestinal bleeding: A case report. World J Clin Cases 2021; 9:9670-9679. [PMID: 34877305 PMCID: PMC8610885 DOI: 10.12998/wjcc.v9.i31.9670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Brunner’s gland hyperplasia (BGH) is a rare benign lesion of the duodenum. Lipomatous pseudohypertrophy (LiPH) of the pancreas is an extremely rare disease. Because each condition is rare, the probability of purely coincidental coexistence of both conditions is extremely low.
CASE SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion. Histopathological examination of the duodenal biopsy specimens showed BGH. Besides, abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas, confirmed by histopathological evaluation on percutaneous pancreatic biopsies. Based on the radiological and histological findings, LiPH of the pancreas and BGH were diagnosed. The patient refused any surgical intervention. Therefore, he was managed with supportive treatment. The patient’s symptoms improved and there was no further bleeding.
CONCLUSION This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.
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Affiliation(s)
- Long Cong Nguyen
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Gastroenterology, School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi 10000, Viet Nam
| | - Khanh Truong Vu
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Gastroenterology, School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi 10000, Viet Nam
| | - Trang Thi Thuy Vo
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Chau Ha Trinh
- Radiology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Tan Dang Do
- Radiology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Ngoc Thi Van Pham
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Tuyen Van Pham
- Pathology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | | | - Hiep Canh Nguyen
- Pathology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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Gwak SY, Lee MK, Lee YK. A Case of a Bleeding Duodenal Lipoma Successfully Controlled by Endoscopic Resection. Clin Endosc 2019; 53:236-240. [PMID: 31337193 PMCID: PMC7137560 DOI: 10.5946/ce.2019.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/29/2019] [Indexed: 12/20/2022] Open
Abstract
This is a case report of successful endoscopic resection (ER) of a bleeding duodenal lipoma. An 85-year-old woman who was diagnosed with asymptomatic subepithelial tumor of the duodenum 3 years ago visited the emergency room with hematemesis and was admitted to our hospital. Emergent esophagogastroduodenoscopy revealed bleeding from an ulcer on the superior aspect of a subepithelial tumor measuring about 20 mm in diameter, at the superior duodenal angle. The ulcer was in the active stage (A1), with a visible vessel. The bleeding was controlled by ER of the tumor using a snare. The final pathological diagnosis was duodenal lipoma with mucosal ulceration. The patient showed no signs of bleeding for 10 days after the procedure; subsequently, she was discharged and followed up for regular checkups.
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Affiliation(s)
- Seo Yeon Gwak
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Lee
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Kang Lee
- Department of Internal Medicine and Institute of Gastroenterology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Pei MW, Hu MR, Chen WB, Qin C. Diagnosis and Treatment of Duodenal Lipoma: A Systematic Review and a Case Report. J Clin Diagn Res 2017; 11:PE01-PE05. [PMID: 28892976 PMCID: PMC5583857 DOI: 10.7860/jcdr/2017/27748.10322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/05/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Duodenal lipoma is very rare with limited case reports present in literature. Owing to recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, no systematic study of duodenal lipomas has been reported. AIM To study the diagnosis and treatment of duodenal lipoma in a female patient and review the relative literatures to enhance the knowledge of it. MATERIALS AND METHODS A literature search for 'duodenal lipoma' was performed on PubMed. Papers published from 1948 to 2016 in the English language were identified. Each article was then read in detail and analysed for clinical data, imaging features, diagnosis and therapy. Also, we hereby present a case of upper gastrointestinal obstruction secondary to multiple duodenal lipomas in a 67-year-old woman. The patient underwent a limited bowel resection with an uneventful recovery. RESULTS Literature review demonstrated 59 cases of duodenal lipoma, which indicate that duodenal lipomas are rare to occur but commonly found in the second part. The peak of incidence seems to be around the fifth and seventh decade of life. Duodenal lipomas may present as gastrointestinal bleeding, abdominal pain, obstruction or upper abdominal fullness. CT, MRI, Endoscopic Ultrasound (EUS), endoscopy are highly accurate diagnostic tools. The disease could be managed by endoscopy or surgery. CONCLUSION Our review of literature indicated duodenal lipoma is extremely rare. The symptoms are nonspecific and CT is the first choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour.
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Affiliation(s)
- Mao Wei Pei
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Ming Rong Hu
- Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Wen Bin Chen
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Chao Qin
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
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Yatagai N, Ueyama H, Shibuya T, Haga K, Takahashi M, Nomura O, Sakamoto N, Osada T, Yao T, Watanabe S. Obscure gastrointestinal bleeding caused by small intestinal lipoma: a case report. J Med Case Rep 2016; 10:226. [PMID: 27520963 PMCID: PMC4983028 DOI: 10.1186/s13256-016-1014-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/24/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Small intestinal lipomas are rare, usually asymptomatic, and most commonly encountered incidentally during investigation of the gastrointestinal tract for another reason. However, they may cause obscure gastrointestinal bleeding. CASE PRESENTATION We report a case of obscure gastrointestinal bleeding due to a small intestinal lipoma. A 69-year-old Japanese man on antiplatelet therapy presented to our department with tarry stools and anemic symptoms. A small intestinal tumor was detected by capsule endoscopy and double-balloon endoscopy. After laparoscopic resection, the tumor was confirmed to be a lipoma. CONCLUSIONS Small intestinal lipomas are difficult to detect by conventional modalities, but capsule endoscopy and double-balloon endoscopy are good modalities for the diagnosis of small intestinal lipomas. Treatment of small intestinal lipomas should be selected carefully, considering the tumor size, size of stalk, administration of antithrombotic therapy, and endoscopic operability.
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Affiliation(s)
- Noboru Yatagai
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Masahito Takahashi
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Taro Osada
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Zirpe D, Wani M, Tiwari P, Ramaswamy PK, Kumar RP. Duodenal Lipomatosis as a Curious Cause of Upper Gastrointestinal Bleed: A Report with Review of Literature. J Clin Diagn Res 2016; 10:PE01-4. [PMID: 27437304 DOI: 10.7860/jcdr/2016/19851.7881] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
Abstract
Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules.
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Affiliation(s)
- Dinesh Zirpe
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | - Majid Wani
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | - Priyanka Tiwari
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | | | - Reddy Prasanna Kumar
- Senior Consultant, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
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8
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Gaspar JP, Stelow EB, Wang AY. Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 2016; 22:600-17. [PMID: 26811610 PMCID: PMC4716062 DOI: 10.3748/wjg.v22.i2.600] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 10/14/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often dictates the work-up and possible therapeutic options. Subepithelial lesions that can arise in the duodenum include lipomas, gastrointestinal stromal tumors, and carcinoids. Endoscopic ultrasonography with fine needle aspiration is useful in the characterization and diagnosis of subepithelial lesions. Duodenal gastrointestinal stromal tumors and large or multifocal carcinoids are best managed by surgical resection. Brunner's gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas are mucosally-based duodenal lesions, which can require removal and are typically amenable to endoscopic resection. Several anatomic characteristics of the duodenum make endoscopic resection of duodenal lesions challenging. However, advanced endoscopic techniques exist that enable the resection of large mucosally-based duodenal lesions. Endoscopic papillectomy is not without risk, but this procedure can effectively resect ampullary adenomas and allows patients to avoid surgery, which typically involves pancreaticoduodenectomy. Endoscopic mucosal resection and its variations (such as cap-assisted, cap-band-assisted, and underwater techniques) enable the safe and effective resection of most duodenal adenomas. Endoscopic submucosal dissection is possible but very difficult to safely perform in the duodenum.
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9
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Casado Morentin I, Ibarra Ponce de Leon C, Pazo Meijide P, Zaballa Iñiguez M. [Endoscopic treatment of giant duodenal lipoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 38:301-2. [PMID: 25073679 DOI: 10.1016/j.gastrohep.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/27/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ignacio Casado Morentin
- Unidad de Endoscopia, Servicio de Digestivo, Hospital de Cruces, Barakaldo, Bizkaia, España.
| | | | - Pilar Pazo Meijide
- Unidad de Endoscopia, Servicio de Digestivo, Hospital de Cruces, Barakaldo, Bizkaia, España
| | - Manuel Zaballa Iñiguez
- Unidad de Endoscopia, Servicio de Digestivo, Hospital de Cruces, Barakaldo, Bizkaia, España
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10
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Yaman İ, Derici H, Paksoy S. Symptomatic duodenal lipoma with endoscopic snare polypectomy. ULUSAL CERRAHI DERGISI 2014; 30:103-5. [PMID: 25931905 DOI: 10.5152/ucd.2014.2069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/19/2013] [Indexed: 11/22/2022]
Abstract
Duodenal lipomas are extremely rare benign tumors. 90% arise from the submucosa and is usually localized in the second portion. They are usually asymptomatic and are detected incidentally during endoscopy or surgery. Appearance of symptoms are related to lesion size, those greater than four centimeters frequently may cause intussusception, obstruction or bleeding. A 59- year-old woman presented with complaints of abdominal fullness in the upper quadrants after meals, and heartburn symptoms. She had been under treatment for iron deficiency anemia during the last five months. The upper gastrointestinal endoscopy revealed a mobile, 4×2 cm polypoid mass extending from the second portion of the duodenum to the third portion, with a regular mucosa and wide pedicle. Saline and epinephrine was injected to polyp base and "snare" polypectomy was performed. Patient's complaint of fullness in the upper part of the abdomen declined after polypectomy and the treatment of anemia was discontinued after a month, with normal blood count values in the fourth month.
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Affiliation(s)
- İsmail Yaman
- Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Hayrullah Derici
- Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Serpil Paksoy
- Department of Pathology, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
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11
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Parmar AK, Bibyan M, Khandelwal R, Reddy PK. Laparoscopic management of a large duodenal lipoma presented as gastric outlet obstruction. JSLS 2013; 17:459-62. [PMID: 24018087 PMCID: PMC3771769 DOI: 10.4293/108680813x13654754535395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic excision of duodenal lipoma may be an effective alternative when endoscopic excision is not feasible. Lipoma of the duodenum is a rare tumor, with fewer than 230 cases reported to date. A majority of these tumors were managed by endoscopic and open surgical intervention, with published data on one case that was managed by total laparoscopy. We report a case of a 43-year-old woman with signs and symptoms of gastric outlet obstruction who was diagnosed as having a large duodenal lipoma that was managed successfully with laparoscopic excision.
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Affiliation(s)
- Amit Kumar Parmar
- Department of Minimal Access Surgery, Apollo Hospital, Chennai, Tamil Nadu, India
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12
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Chen HT, Xu GQ, Wang LJ, Chen YP, Li YM. Sonographic features of duodenal lipomas in eight clinicopathologically diagnosed patients. World J Gastroenterol 2011; 17:2855-9. [PMID: 21734794 PMCID: PMC3120946 DOI: 10.3748/wjg.v17.i23.2855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 04/19/2011] [Accepted: 04/26/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the sonographic features and diagnostic value of endoscopic ultrasonography (EUS) for duodenal lipomas (DLs).
METHODS: A total of eight consecutive patients with DL diagnosed pathologically were included in the study. One EUS expert reviewed the ultrasonic images for all lesions, including the original layer of the duodenal wall, the echo intensity and the echo homogeneity. The size of the lesions and the perifocal structures were also investigated. The diagnosis by EUS was compared with the histological results.
RESULTS: Using routine endoscopy, only one case was correctly diagnosed as DL. Four cases were classified as submucosal tumors, and three cases were mistaken for stromal tumors. All tumors appeared as round or oval intensive hyperechoic lesions with distinct anterior borders that originated from the submucosal layer on EUS. Tumors ranged from 8 to 36 mm in size, with an average size of 16 mm. Homogeneous echogenicity was seen in all cases except one that had a tubular structure inside the tumor. Echo attenuation was observed only in the area behind the tumors in five cases, and it was observed both inside and behind the tumors in three cases in which the posterior border was obscure or invisible. Seven (87.5%) cases were correctly diagnosed as DL, and one (12.5%) was mistaken as Brunner’s gland adenoma by EUS. Pathologically, all tumors originated from the submucosal layer and consisted of mature fat cells without heteromorphism. Among the fat cells, there was a small amount of thick-wall vessels infiltrating the lymphocytes, and abundant fibrous connective tissues.
CONCLUSION: On EUS, DL is featured as an intensive homogeneous hyperechoic submucosal lesion with marked echo attenuation and without involvement of the mucosa.
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13
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Kadaba R, Bowers KA, Wijesuriya N, Preston SL, Bray GB, Kocher HM. An unusual cause of gastrointestinal bleeding: duodenal lipoma. Case Rep Gastroenterol 2011; 5:183-8. [PMID: 21552442 PMCID: PMC3088745 DOI: 10.1159/000327219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.
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Affiliation(s)
- R Kadaba
- Barts and The London HPB Centre, The Royal London Hospital, London, UK
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14
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Chang CW, Chu CH, Shih SC, Chen MJ, Yang TL, Chang WH. Duodenal polypoid lipoma with bleeding. Am J Surg 2010; 200:e49-e50. [PMID: 20538251 DOI: 10.1016/j.amjsurg.2010.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 01/08/2023]
Abstract
Duodenal lipomas are rare; most are asymptomatic and are found incidentally via endoscopy or surgery. We report a case of duodenal polypoid lipoma with active bleeding. Although endoscopic treatment was scheduled initially, surgical intervention ultimately was indicated.
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Affiliation(s)
- Chen-Wang Chang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-Shan N Rd., Taipei, Taiwan
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15
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Huang WH, Peng CY, Yu CJ, Chou JW, Feng CL. Endoloop-assisted unroofing for the treatment of symptomatic duodenal lipomas. Gastrointest Endosc 2008; 68:1234-6. [PMID: 19028236 DOI: 10.1016/j.gie.2008.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 03/03/2008] [Indexed: 12/13/2022]
Affiliation(s)
- Wen-Hsin Huang
- Department of Internal Medicine, Division of Hepatogastroenterology, China Medical University Hospital, Taichung, Taiwan
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16
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Yu HG, Ding YM, Tan S, Luo HS, Yu JP. A safe and efficient strategy for endoscopic resection of large, gastrointestinal lipoma. Surg Endosc 2007; 21:265-269. [PMID: 17122972 DOI: 10.1007/s00464-006-0059-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 04/27/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign, slowly growing, submucosal tumors, which may cause gastrointestinal bleeding, anemia, intussusception, and bowel obstruction. The aim of this study is to explore the safe and effective strategy for endoscopic removal of large GI lipomas. METHODS During last 10 years, fifteen large and symptomatic GI lipomas were resected under endoscopy in our hospital. In them, two large lipomas with small stalk (< 2 m in diameter) were resected by polypectomy; ten large lipomas with base size greater than 2 cm in diameter were removed using a "subtotal resection." Three other large lipomas with small stalk (< 2 m in diameter) were resected by multistep resection. Endoscopic ultrasonography (EUS) and miniprobe endoscopic ultrasound were performed in six cases from January 2000 to July 2004 to confirm that those lesions were lipomas that were superficial to the muscularis propria. RESULTS All 15 lesions were successfully removed and were histopathologically confirmed to be lipomas. No severe complications, such as perforation or hemorrhage, developed after endoscopic removal. No recurrence was observed after 1-8 years follow-up endoscopic examination. CONCLUSIONS Various, large GI lipomas can be removed safely by electrosurgical snare resection under endoscopy following the guidance of the present therapeutic strategy.
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Affiliation(s)
- H-G Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, 430060, Wuhan, People's Republic of China.
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Sou S, Nomura H, Takaki Y, Nagahama T, Matsubara F, Matsui T, Yao T. Hemorrhagic duodenal lipoma managed by endoscopic resection. J Gastroenterol Hepatol 2006; 21:479-81. [PMID: 16509883 DOI: 10.1111/j.1440-1746.2006.03178.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The patient, an 81-year-old woman, was admitted to our hospital for a detailed examination; the chief complaint being melena. An upper gastrointestinal roentgenologic study revealed a submucosal tumor with a smooth surface and a stalk measuring 50 mm at the third part of the duodenum. Endoscopy depicted it as a yellowish submucosal tumor. Based on computed tomography and fluoroscopy of the small intestine, a diagnosis of duodenal lipoma was made. The esophagus, stomach, and the small and large intestines were free of lesions so the duodenal lipoma was judged to be the hemorrhagic source. The tumor was endoscopically polypectomized using a 2-channel scope. The excised specimen, measuring 50 x 20 x 20 mm, was covered by a normal duodenal mucosa with small ulcers in part. Photomicrographic findings included a tumor that was composed of mature adipose tissue in the submucosa, which coincided with a diagnosis of lipoma. Small ulcers had formed in part, exposing vessels, thus indicating the cause for hemorrhage. Lipoma is a benign tumor; and if the lesion is found to be pedunculated and an endoscope can reach it for treatment, minimally invasive endoscopic procedures should be selected.
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Affiliation(s)
- Suketo Sou
- Department of Gastroenterology, Shin-Kokura Hospital, Kanada, Kokurakita-ku, Kitakyushu, Japan.
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Shoji T, Taniwaka K, Goto H, Fukasawa T, Akaike H, Tabata M. A CASE OF DUODENAL LIPOMA REMOVED BY ENDOSCOPIC POLYPECTOMY. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00389.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Blanchet MC, Arnal E, Paparel P, Grima F, Voiglio EJ, Caillot JL. Obstructive duodenal lipoma successfully treated by endoscopic polypectomy. Gastrointest Endosc 2003; 58:938-9. [PMID: 14652572 DOI: 10.1016/s0016-5107(03)02232-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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