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Chaouch MA, Taieb AH, Maaref M, Baccari L, Saad J, Noomen F. Laparoscopic resection of a gastric lipoma following massive upper gastrointestinal bleeding: A case report. Int J Surg Case Rep 2024; 120:109876. [PMID: 38878729 PMCID: PMC11226956 DOI: 10.1016/j.ijscr.2024.109876] [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: 05/07/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
IMPORTANCE AND BACKGROUND Gastric lipomas are rare submucosal tumours that account for less than 1 % of all stomach tumours. Despite their benign nature, they can lead to significant clinical manifestations such as gastric outlet obstruction and massive gastrointestinal haemorrhage. CASE PRESENTATION We report the case of a 50-year-old woman with no prior comorbidities, presenting with severe upper gastrointestinal bleeding. Diagnostic imaging and endoscopy identified a submucosal mass in the prepyloric area, later confirmed to be a gastric lipoma. The surgical intervention involved laparoscopic resection of the mass. DISCUSSION This case underscores the importance of considering gastric lipomas in differential diagnoses of gastrointestinal bleeding. While often asymptomatic, their potential to cause acute complications necessitates awareness among clinicians. The management strategies range from observational approaches in asymptomatic cases to surgical excision in symptomatic cases. CONCLUSIONS Gastric lipomas, though rare and often benign, can present with life-threatening complications. Accurate diagnosis using a combination of endoscopy and imaging, particularly CT scans, is critical for effective management. Surgical removal remains the definitive treatment for symptomatic lipomas, highlighting the need for a tailored approach based on the tumour's characteristics and location.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Maaref
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Louay Baccari
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Jamal Saad
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive, Monastir University Hospital, Monastir, Tunisia
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2
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Jain S, Thanage R, Nair S, Chandnani S, Debnath P, Patel S, Kamat R, Rathi P. A case of giant colonic lipoma removed endoscopically using a modified hybrid technique. Med J Armed Forces India 2023; 79:S267-S269. [PMID: 38144667 PMCID: PMC10746737 DOI: 10.1016/j.mjafi.2021.06.024] [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: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022] Open
Abstract
Colonic lipomas are benign adipose tumors and are mostly asymptomatic. They may cause symptoms when their size becomes more than 2 cm. Giant colonic lipoma (GCL) is a rare finding in endoscopy which presents with or without macroscopic ulceration and may lead to iron deficiency anaemia (IDA). The choice of treatment of symptomatic large colonic lipomas has been controversial. Here we are presenting a case of GCL presenting with occult bleeding causing iron deficiency anaemia (IDA). It was removed endoscopically using a combination of noradrenaline, endoloop ligation, and snare cautery technique (modified hybrid technique). Successful removal of the GCL lead to the resolution of IDA. This case report highlights that even GCL can be removed endoscopically, thus surgery can be prevented. Clinical Significance: GCL is an unusual cause of anemia. Modified hybrid endoscopic removal technique improves safety.
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Affiliation(s)
- Shubham Jain
- Assistant Professor (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Ravi Thanage
- Assistant Professor (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Sujit Nair
- Assistant Professor (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Sanjay Chandnani
- Assistant Professor (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Partha Debnath
- Senior Resident (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Sameet Patel
- Senior Resident (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Rima Kamat
- Additional Professor (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Pravin Rathi
- Professor (Gastroenterology), Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
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3
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Muacevic A, Adler JR, Alsolmi AA, Fakhri AF. Duodenal Lipoma As Upper Gastrointestinal Bleeding Presentation: Case Report and Review of the Literature. Cureus 2023; 15:e33996. [PMID: 36811043 PMCID: PMC9939013 DOI: 10.7759/cureus.33996] [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: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Duodenal lipomas (DLs) are rare benign nonepithelial tumors that account for 4% of all gastrointestinal (GI) lipomas. DLs can occur in any part of the duodenum but most commonly arise in the second part of the duodenum. They are usually asymptomatic and discovered incidentally but may present with GI hemorrhage, bowel obstruction, or abdominal pain and discomfort. The diagnostic modalities can be based on radiological studies and endoscopy with the aid of endoscopic ultrasound (EUS). DLs can be managed either endoscopically or surgically. We report a case of symptomatic DL presenting with upper GI hemorrhage along with a review of the literature. We report a case of a 49-year-old female patient who presented with a one-week history of abdominal pain and melena. Upper endoscopy revealed a single, large pedunculated polyp with an ulcerated tip in the first part of the duodenum. EUS confirmed features suggestive of a lipoma, including an intense homogeneous hyperechoic mass originating from the submucosa. The patient underwent endoscopic resection, with excellent recovery. The rare occurrence of DLs requires a high index of suspicion and radiological endoscopic assessment to rule out invasion into the deeper layers. Endoscopic management is associated with good outcomes and a decreased risk of surgical complications.
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4
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Yang B, Jiang F, Lu P, Han H. Minimally invasive management of large duodenal lipoma: endoscopic submucosal dissection. J Int Med Res 2021; 49:3000605211066397. [PMID: 34939876 PMCID: PMC8721732 DOI: 10.1177/03000605211066397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to compare the clinical outcomes of large duodenal lipomas (DLs) of ≥2 cm between endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). Methods This retrospective study included patients who underwent endoscopic resection of large DLs from June 2017 to March 2021 at our hospital. Clinicopathologic features, clinical outcomes, and follow-up endoscopy findings were retrospectively reviewed. Results Twenty-three patients (12 men) with a mean age of 57.4 years were included. The median tumor size was 28.4 ± 13.3 mm. ESD was performed in 19 patients, and EFTR was performed in 4. Complete resection was achieved in 21 patients. The operative time and postoperative hospital stay were significantly shorter in the ESD than EFTR group. Four patients in the EFTR group developed a fever; no other adverse events occurred. No patients required surgical intervention. During the average follow-up of 21.1 months, no residual tumor, recurrence, or metastasis was observed. Conclusion Both ESD and EFTR provide minimally invasive, localized treatment of selected DLs. ESD might have some advantages in resecting large DLs in terms of procedure time and hospitalization.
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Affiliation(s)
| | | | | | - Huazhong Han
- Huazhong Han, Department of General Surgery, Shanghai Xuhui Center Hospital, 966 Huaihai Road (M), Xuhui District, Shanghai 200030, China.
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5
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Glosser LD, Lombardi CV, Knauss HM, Hopper W, Alalwan A, Stanek S. Treatment of duodenal lipoma with robotic-assisted transverse duodenotomy: A case report of novel approach. Int J Surg Case Rep 2021; 86:106366. [PMID: 34507195 PMCID: PMC8433243 DOI: 10.1016/j.ijscr.2021.106366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Lipomas are the third most common benign tumor of the gastrointestinal (GI) tract, typically occurring in the colon or small intestine. Less than 100 cases of symptomatic duodenal lipomas have been reported. Symptoms include non-specific upper GI complaints of heartburn, fullness, or abdominal pain. This report highlights the rarity of symptomatic duodenal lipomas, lack of specific treatment guidelines, and adds to surgical literature a new treatment approach. Case presentation A 53-year-old Caucasian woman presented with 2-year history with main concerns for early satiety and constipation. CT scan with contrast of the abdomen and pelvis demonstrated a duodenal mass. Differential diagnosis included duodenal lipoma versus stricture, and IBS. Subsequent EGD revealed a 4 cm transverse duodenal submucosal mass. Endoscopic removal was deemed too great a risk of bleeding. Pre-operatively, the patient expressed frustration as the patient was tolerating only a liquid diet with one bowel movement weekly. Treatment with robotic assisted transverse duodenotomy was performed, with final pathology of benign lipomatous tissue. Post-operatively the patient had immediate relief of symptoms which persisted at 2-week and 4-month follow-ups. Clinical discussion This case demonstrates 3 primary learning points. First, duodenal lipomas should be included in the differential of vague upper GI symptoms. Second, we propose that surgeons consider treatment of duodenal lipomas utilizing robotic assisted approach. Third, we document the first robotic-assisted transverse duodenotomy for duodenal lipomas. Conclusion Clinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy. Only a few cases of symptomatic duodenal lipoma have been reported. No specific treatment guidelines exist for duodenal lipomas. First-reported treatment of duodenal lipoma via robotic-assisted transverse duodenotomy
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Affiliation(s)
- Logan D Glosser
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, USA.
| | - Conner V Lombardi
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Hanna M Knauss
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Wade Hopper
- University of Toledo College of Medicine and Life Sciences, Department of General Surgery, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Abdullah Alalwan
- Edward via College of Osteopathic Medicine, 350 Howard St, Spartanburg, SC 29307, USA
| | - Stephen Stanek
- Toledo Promedica, Dept. of General Surgery, 2142 N Cove Blvd, Toledo, OH 43606, USA
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6
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Deshmukh A, Elmeligui A, Parsa N, Tejedor-Tejada J, Nieto J. Successful removal of a giant esophageal lipoma with hybrid endoscopic submucosal dissection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:398-400. [PMID: 34527835 PMCID: PMC8431273 DOI: 10.1016/j.vgie.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Endoscopic submucosal dissection of a giant esophageal lipoma.
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Affiliation(s)
- Ameya Deshmukh
- Department of Internal Medicine, Saint Louis University - SOM, St. Louis, Missouri
| | - Ahmed Elmeligui
- Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo, Egypt
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri Health System, Columbia, Missouri
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida
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7
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Okamoto T, Ikeya T, Fukuda K. Endoscopic submucosal dissection with a scissors-type knife for colonic lipoma. Endosc Int Open 2021; 9:E1023-E1025. [PMID: 34222625 PMCID: PMC8211476 DOI: 10.1055/a-1485-1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
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8
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Experience with Esophageal Granular Cell Tumors: Clinical and Endoscopic Analysis of 22 Cases. Dig Dis Sci 2021; 66:1233-1239. [PMID: 32474763 DOI: 10.1007/s10620-020-06337-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Esophageal granular cell tumors (GCTs) are rare tumors. Differences in reports on the clinical features of GCTs in the esophagus and some controversies about the diagnostic strategy for esophageal GCTs exist. OBJECTIVES We aimed to investigate the clinical features and diagnosis of esophageal GCTs. Additionally, we sought to determine the prevalence of gastroesophageal reflux disease and reflux esophagitis in patients with esophageal GCTs. METHODS We retrospectively studied the clinical features, endoscopic features, and management of 22 patients with esophageal GCTs. RESULTS Esophageal GCTs were more common in men than in women with a ratio of 1.2:1 and were predominantly found in the distal esophagus. Ten patients with esophageal GCTs had regurgitation and/or heartburn symptoms, and eight patients were confirmed to have reflux esophagitis by endoscopy. All esophageal GCTs were protuberant lesions covered by normal esophageal epithelium. The endoscopic morphology of esophageal GCTs was diverse. On endoscopic ultrasonography, these tumors appeared as homogeneous or inhomogeneous hypoechoic lesions with clear borders originating from the submucosal or mucosal layer. Eleven patients underwent endoscopic forceps biopsy at the first endoscopy, and only six patients were correctly diagnosed by pathology. Nevertheless, the 18 lesions treated with endoscopic resection were all correctly diagnosed without complications, and no patients developed recurrence during the follow-up period. CONCLUSIONS The occurrence of esophageal GCTs may be related to esophageal inflammation. As a method for obtaining an accurate pathological diagnosis and for treatment, endoscopic resection should be offered as the primary option for patients with esophageal GCTs.
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9
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Sabbah M, Nakhli A, Helal I, Bellil N, Ouakaa A, Gargouri D. Gastrointestinal bleeding as an initial manifestation of gastric lipoma: Case report and review of the literature. Clin Case Rep 2020; 8:1988-1992. [PMID: 33088535 PMCID: PMC7562860 DOI: 10.1002/ccr3.3050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/01/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022] Open
Abstract
Gastric lipoma should be considered as a rare differential diagnosis in patients presenting with gastrointestinal bleeding. Diagnosis is mainly done by radiologic and endoscopic findings. It presents characteristic pathognomonic endoscopic signs.
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Affiliation(s)
- Meriam Sabbah
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Abdelwahab Nakhli
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Imen Helal
- Faculty of Medicine of Tunis University of Tunis El Manar Tunisia.,Department of Pathology Habib Thameur Hospital Tunis Tunisia
| | - Nawel Bellil
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Asma Ouakaa
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Dalila Gargouri
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
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Cuciureanu T, Huiban L, Chiriac S, Singeap AM, Danciu M, Mihai F, Stanciu C, Trifan A, Vlad N. Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report. World J Clin Cases 2019; 7:3765-3771. [PMID: 31799302 PMCID: PMC6887596 DOI: 10.12998/wjcc.v7.i22.3765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/29/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intestinal lipomas are rare benign gastrointestinal (GI) tumors, usually asymptomatic, but may become symptomatic as the result of some complications such as intussusception, intestinal obstruction, volvulus or bleeding. They can occur at any site along the entire GI tract, more frequent in colon and rarely in small intestine. The patient reported here is a very rare case of jejunal lipoma, ulcerated and intussuscepted, diagnosed in an adult investigated for a chronic iron deficiency anemia (IDA), and successfully managed by segmental jejunal resection.
CASE SUMMARY A 63-year-old male was referred to “St. Spiridon” Hospital, Institute of Gastroenterology and Hepatology, Iasi, to investigate an obscure GI bleeding with an IDA. After upper GI endoscopy and colonoscopy were performed, excluding potentially bleeding lesions, videocapsule endoscopy was then carried out, revealing fresh blood and a protruding lesion in proximal jejunum, findings confirmed by a single-balloon enteroscopy. Multiple biopsies were taken from the lesion, but histological results were inconclusive. Then, contrast - enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density, suggestive for lipoma. A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected en bloc, and sent for further histopathologic analysis. The patient made an uneventful recovery and was discharged seven days later, and at six months follow-up he had no complains and his hemoglobin returned to normal value.
CONCLUSION Lipomas are very rarely located in the jejunum, usually asymptomatic, but they may lead to complications such as intussusception and bleeding. Surgical resection remains the treatment of choice.
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Affiliation(s)
- Tudor Cuciureanu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Laura Huiban
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Stefan Chiriac
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Ana-Maria Singeap
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Mihai Danciu
- Department of Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Florin Mihai
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Carol Stanciu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
| | - Nutu Vlad
- Department of General Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Iasi 700115, Romania
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11
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Sullivan IW, Hota P, Dass C. Gastric lipomas: a case series and review of a rare tumor. BJR Case Rep 2019; 5:20180109. [PMID: 31501708 PMCID: PMC6726183 DOI: 10.1259/bjrcr.20180109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between -80 and -120. A single lipoma measuring -50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.
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Affiliation(s)
- Ian W Sullivan
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
| | | | - Chandra Dass
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
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12
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Novel surgical approach without bowel resection for multiple gastrointestinal lipomatosis: A case report. Int J Surg Case Rep 2019; 59:54-57. [PMID: 31103954 PMCID: PMC6599446 DOI: 10.1016/j.ijscr.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/02/2019] [Indexed: 01/17/2023] Open
Abstract
We experienced GI lipomatosis existing from the duodenum to the small intestine. In case of multiple lipomas, resection procedure and range cannot be determined. Intestinal lipomas were resected with local excision without any bowel resection. And duodenal lipoma was resected with ESD. Local excision + ESD seemed to be one of the methods in resecting lipomatosis.
Introduction Asymptomatic lipoma only requires observation, whereas symptomatic lipoma requires treatment such as endoscopic or surgical resection. However, in case of multiple lipomas, with evident diffusion and malignancy, resection procedure and range cannot be determined. We experienced GI lipomatosis (multiple lipomas) diffusely existing from the duodenum to the small intestine and involved recurrent intussusception. Presentation of case 47 year-old female was a history of open bowel resection for intestinal obstruction caused by intussusceptions of multiple small intestinal lipoma 11 years ago. EGD showed duodenal lipoma, and CT showed diffuse multiple lipomas from the proximal jejunum to the distal ileum. Another CT also showed intussusception of small intestine, but no signs of intestinal obstruction. Surgical procedures performed included diagnostic laparoscopy. All intestinal lipomas were resected with local excision, and duodenal lipoma was resected with ESD without any bowel resection. Discussion Multiple local excision ESD for multiple GI lipomatosis have not been reported. The most problematic thing is that if extensive resection is performed to cut off all multiple lipoma, short bowel syndrome may occur. Determining the range to be cut remains unclear. Conclusions Multiple local excision ± ESD seemed to be one of the methods in resecting multiple GI lipomatosis. In the future, cases and indications of surgery and resection method for GI lipoma should be accumulated and considered, respectively.
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13
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Ingason AB, Theodors A, Agustsson AS, Arnarson A. Giant gastric lipoma successfully removed by endoscopic submucosal dissection: case report and systematic review. Scand J Gastroenterol 2018; 53:1018-1024. [PMID: 30134740 DOI: 10.1080/00365521.2018.1495259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Gastric lipomas are rare adipose tumors that constitute less than 1% of gastric tumors. While lipomas generally do not need removal unless symptomatic, endoscopic resection has been proposed as safe for gastric lipomas smaller than 2 cm. Yet, there is no consensus on the optimal treatment method for larger lipomas. We report a case of a giant 7-cm gastric lipoma successfully removed by endoscopic submucosal dissection (ESD) and systematically review the literature for gastric lipomas removed by ESD. METHODS Systematic review was conducted by searching PubMed and Scopus databases, up to 15 February 2018, using combinations of relevant terms. RESULTS We report a 55-year-old male with known gastroesophageal reflux disease and asthma, who sought medical attention due to chronic heartburn and asthma exacerbations. These symptoms were attributed to a large 7 cm × 3 cm gastric lipoma that caused gastric outlet obstruction. The lipoma was safely removed by ESD, allowing quick recovery and alleviation of symptoms. In our review, we identified 20 gastric lipomas treated with ESD, with 15 (75%) being 2 cm or larger. The average size of the lipomas was 4 cm (range: 1.2-9 cm). All lipomas were limited to the submucosa, with 80% of the tumors located in the antrum. Three lipomas were removed by submucosal tunneling. All tumors were successfully removed en bloc and no major complications were reported. CONCLUSION Our findings support the conclusion that ESD may be a safe alternative to conventional surgery for removal of large symptomatic gastric lipomas.
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Affiliation(s)
- Arnar B Ingason
- a Department of Medicine , University of Iceland , Reykjavik , Iceland
| | - Asgeir Theodors
- b Department of Gastroenterology , Landspitali University Hospital , Reykjavik , Iceland
| | - Arnar S Agustsson
- a Department of Medicine , University of Iceland , Reykjavik , Iceland
| | - Adalsteinn Arnarson
- c Department of General Surgery , Landspitali University Hospital , Reykjavik , Iceland
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14
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Yagnik VD. Re: Gastric lipoma: a rare cause of gastrointestinal bleeding. ANZ J Surg 2018; 88:118. [PMID: 29392905 DOI: 10.1111/ans.14282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Ronak Endo-Laparoscopy and General Surgical Hospital, Patan, India
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15
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Kumar P, Gray C. Response to Re: Gastric lipoma: a rare cause of gastrointestinal bleeding. ANZ J Surg 2018; 88:118-119. [PMID: 29392902 DOI: 10.1111/ans.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Prashant Kumar
- Department of Anaesthetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Chris Gray
- Department of General Surgery, Timaru Hospital, Timaru, New Zealand
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Kim JH, Yoon HH, Jeong SH, Woo HS, Lee WS, Choi SJ, Kim SG, Ha SY, Kwon KA. Spontaneous peeled ileal giant lipoma caused by lower gastrointestinal bleeding: A case report. Medicine (Baltimore) 2017; 96:e9253. [PMID: 29390483 PMCID: PMC5758185 DOI: 10.1097/md.0000000000009253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Gastrointestinal subepithelial tumors (SETs) with endoscopic features such as ulceration, a red color change, a peeled mucosal layer, and spontaneous bleeding could have malignant potential. However, we encountered a case of a lipoma that presented features different from the generally known features of gastrointestinal SETs. Therefore, we report an interesting rare case of a terminal ileal giant lipoma with a unique feature of spontaneous peeled ulceration on the surface on endoscopy that caused gastrointestinal bleeding. PATIENT An 82-year-old woman with a 1-week history of abdominal pain and hematochezia presented to our hospital. DIAGNOSES Ileocolonoscopy revealed a SET with a peeled surface and erythematous and ulcerative mucosal changes as well as exposed a submucosal mass at the terminal ileum. Macroscopically, the lesion appeared as a yellowish pedunculated polypoid mass measuring 3 × 2 cm with a peeled mucosal ulceration. Histopathological findings revealed a submucosal lipoma of the terminal ileum. INTERVENTION We thought that the endoscopic finding indicated malignant SETs or those with malignant potential rather than benign SETs. Therefore, the patient underwent an elective laparoscopic ileocecectomy. LESSONS We encountered a lipoma that did not present with the typical features of gastrointestinal SETs. Our findings suggest that clinicians should consider that benign SETs in the terminal ileum may present with various endoscopic findings similar to those of malignant SETs, which can cause fatal symptoms and signs.
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Affiliation(s)
- Jung Ho Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon
| | - Hyun Hwa Yoon
- Department of Internal Medicine, Central Hospital, Siheung-si, Gyeonggi-do
| | - Seok Hoo Jeong
- Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital
| | - Hyun Sun Woo
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon
| | | | | | | | - Seung Yeon Ha
- Department of Pathology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Kwang An Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon
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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: 1.7] [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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18
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The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017; 85:1117-1132. [PMID: 28385194 DOI: 10.1016/j.gie.2017.02.022] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
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Noda H, Ogasawara N, Tamura Y, Kondo Y, Izawa S, Ebi M, Funaki Y, Sasaki M, Kasugai K. Successful Endoscopic Submucosal Dissection of a Large Terminal Ileal Lipoma. Case Rep Gastroenterol 2016; 10:506-511. [PMID: 27843426 PMCID: PMC5091281 DOI: 10.1159/000448886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 12/13/2022] Open
Abstract
A 78-year-old woman who had recurrent right lower abdominal pain for about 1 year underwent computed tomography (CT) because of a follow-up observation 1 year after right breast cancer surgery. CT revealed a tumor in the colon. The patient was referred to our hospital for detailed examinations. An abdominal CT showed a low-density tumor of approximately 30 mm in the ascending colon, and the CT density inside the tumor was same as that of fatty tissues. A subsequent colonoscopy showed a submucosal tumor (SMT) in the proximal ascending colon developing from the terminal ileum. A colonoscopic ultrasonography revealed that the SMT was a high-echoic mass mainly localized in the submucosal layer. Based on the findings from CT, colonoscopy, and colonoscopic ultrasonography, the SMT was diagnosed as a pedunculated lipoma originating from the terminal ileum and treated with endoscopic submucosal dissection (ESD) because of recurrent abdominal pain. The 40-mm tumor was resected en bloc without complications. ESD may be more appropriate than polypectomy and surgery for removal of small intestinal tumors, because ESD allows direct visualization of the cutting line and exactly dissects the submucosal layers without damaging the muscular layers. ESD is a potentially useful treatment to remove intestinal lipomas.
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Affiliation(s)
- Hisatsugu Noda
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Naotaka Ogasawara
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yasuhiro Tamura
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshihiro Kondo
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Shinya Izawa
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yasushi Funaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Sasaki
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
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Affiliation(s)
- Diane Lorenzo
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
| | - Jean Michel Gonzalez
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
| | - Alban Benezech
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
| | - Marc Barthet
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
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21
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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: 1.1] [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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22
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Gastric lipoma excision during a laproscopic sleeve gastrecomy: A case report. Int J Surg Case Rep 2016; 24:128-30. [PMID: 27239791 PMCID: PMC4890143 DOI: 10.1016/j.ijscr.2016.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/22/2016] [Accepted: 05/22/2016] [Indexed: 12/16/2022] Open
Abstract
A new management option for patients with submucosal gastric tumors. Combing two procedures in one surgery, maybe beneficial for some submucsal gastric tumors removals. The importance of through preoperative and intraoperative assessment for all bariatric procedures. Surgeon opinion along with patient preference are key factors in any elective operation. This is the second case report in the medical English literature to remove this rare gastric tumor during an elective bariatric surgery.
Introduction Gastric lipomas are rare benign mesenchymal tumors of the stomach. Case report We report a 41 year old, morbid obese male, admitted for elective laparoscopic sleeve gastrectomy. Thorough preoperative assessment revealed a gastric lipoma in the antrum of the stomach measuring 3 × 3 cm. Due to the patient’s preference, surgical resection of the lipoma was done along with the laparoscopic sleeve gastrectomy procedure. Discussion In our case, we report a rare case of submucosal gastric lipoma successfully removed during a laparoscopic sleeve gastrectomy. To our knowledge, this is the second case report in the medical English literature that reports removing this rare gastric tumor during an elective bariatric procedure. Conclusion This case report presents an effective treatment option for patients in need of bariatric procedure and gastric lipoma resection. This case also highlights the importance of through preoperative and intraoperative assessment for all bariatric patients.
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23
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Chou JW, Cheng KS, Lin CP. A large symptomatic jejunal subepithelial tumor treated with endoloop-assisted polypectomy using spiral enteroscopy. Intest Res 2016; 14:104-5. [PMID: 26884743 PMCID: PMC4754515 DOI: 10.5217/ir.2016.14.1.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China.; Taiwan Society of Inflammatory Bowel Disease, Taiwan, Republic of China.; Taiwan Association for the Study of Small Intestinal Diseases, Taiwan, Republic of China
| | - Ken-Sheng Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Ching-Pin Lin
- Division of Gastroenterology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.; Taiwan Society of Inflammatory Bowel Disease, Taiwan, Republic of China.; Taiwan Association for the Study of Small Intestinal Diseases, Taiwan, Republic of China
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24
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Lee JM, Kim JH, Kim M, Kim JH, Lee YB, Lee JH, Lim CW. Endoscopic submucosal dissection of a large colonic lipoma: Report of two cases. World J Gastroenterol 2015; 21:3127-3131. [PMID: 25780315 PMCID: PMC4356937 DOI: 10.3748/wjg.v21.i10.3127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/08/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
A colonic lipoma is a very rare benign tumor that is usually asymptomatic and is found incidentally by colonoscopy. Patients with a large colonic lipoma may present with symptoms such as abdominal pain, bleeding, and colonic obstruction or intussusceptions. We report two patients with large colonic lipomas and symptoms. Standard endoscopic submucosal dissection (ESD) was performed to remove the lipomas instead of conventional surgical bowel resection. No complications were observed during or after the procedure. The tumors were resected en bloc, and the patients were discharged 2 d after ESD with a regular diet. The results indicate that ESD can be applied as safe and effective treatment for a large colonic lipoma.
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25
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Laparoscopy-assisted resection of ileocecal intussusception caused by ileal pedunculated lipoma. Int Surg 2015; 98:330-3. [PMID: 24229019 DOI: 10.9738/intsurg-d-13-00011.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report on a case of ileal lipoma that prolapsed into the ascending colon and was resected by laparoscopy-assisted surgery. A 31-year-old male Japanese patient was admitted to our hospital because of hematochezia and anemia. Colonoscopy revealed a pedunculated polyp arising from the ileum. The surface was covered with slightly edematous mucosa. Abdominal computed tomography showed a low-density mass in the ascending colon. A diagnosis of pedunculated ileal lipoma with intussusception was made, and laparoscopy-assisted surgery was performed. The intussusception was reducted by resection of the lipoma. The surgical specimen was a 40 × 30 × 25 mm round tumor with a long stalk 11 cm in length. Microscopic examination of the specimen revealed ileal lipoma. Laparoscopic surgery is recommended for benign tumors of the small intestine because it is minimally invasive.
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26
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Salah W, Faigel DO. When to puncture, when not to puncture: Submucosal tumors. Endosc Ultrasound 2014; 3:98-108. [PMID: 24955339 PMCID: PMC4064168 DOI: 10.4103/2303-9027.131038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/20/2013] [Indexed: 12/19/2022] Open
Abstract
Subepithelial masses of the gastrointestinal (GI) tract are a frequent source of referral for endosonographic evaluation. Subepithelial tumors most often appear as protuberances in the GI tract with normal overlying mucosa. When there is a need to obtain a sample of the mass for diagnosis, endoscopic ultrasound (EUS) - guided fine-needle aspiration (FNA) is superior to other studies and should be the first choice to investigate any subepithelial lesion. When the decision is made to perform EUS-guided FNA several technical factors must be considered. The type and size of the needle chosen can affect diagnostic accuracy, adequacy of sample size and number of passes needed. The use of a stylet or suction and a fanning or standard technique during EUS-guided FNA are other factors that must be considered. Another method proposed to improve the efficacy of EUS-guided FNA is having an on-site cytopathologist or cytotechnician. Large or well-differentiated tumors may be more difficult to diagnose by standard EUS-FNA and the use of a biopsy needle can be used to acquire a histopathology sample. This can allow preservation of tissue architecture and cellularity of the lesion and may lead to a more definitive diagnosis. Alternatives to FNA such as taking bite-on-bite samples and endoscopic submucosal resection (ESMR) have been studied. Comparison of these two techniques found that ESMR has a significantly higher diagnostic yield. Most complications associated with EUS-FNA such as perforation, infection and pancreatitis are rare and the severity and incidence of these adverse events is not known. Controversy exists as to the optimal method in which to perform EUS-FNA and larger prospective trials are needed.
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Affiliation(s)
- Wajeeh Salah
- Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
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27
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Figueiredo PC, Pinto-Marques P, Mendonça E, Oliveira P, Brito M, Serra D. Duodenal subepithelial hyperechoic lesions of the third layer: Not always a lipoma. World J Gastrointest Endosc 2013; 5:514-518. [PMID: 24147196 PMCID: PMC3797905 DOI: 10.4253/wjge.v5.i10.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasonography is the most accurate procedure for the evaluation of subepithelial lesions. The finding of a homogeneous, hyperechoic, well-delimited lesion, originating from the third layer of the gastrointestinal tract (submucosa) suggests a benign tumor, generally lipoma. As other differential diagnoses have not been reported, echoendoscopists might not pursue a definitive pathological diagnosis or follow-up the patient. This case series aims to broaden the spectrum of differential diagnosis for duodenal hyperechoic third layer subepithelial lesions by providing four different and relevant pathologies with this echoendoscopic pattern.
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28
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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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29
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Lee KJ, Kim GH, Park DY, Shin NR, Lee BE, Ryu DY, Kim DU, Song GA. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 2013; 28:185-92. [PMID: 23996333 DOI: 10.1007/s00464-013-3151-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/22/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign, slow-growing subepithelial tumors. Most lipomas are detected incidentally at endoscopy, but they can cause GI bleeding, abdominal pain, intestinal obstruction, and intussusception, particularly if they are larger than 2 cm in diameter. The aim of this study was to investigate the efficacy, safety, and long-term prognosis of endoscopic treatment of GI lipomas. METHODS A total of 28 GI lipomas treated endoscopically from January 2005 to June 2012 were retrospectively reviewed. Endoscopic treatment was performed by four methods: the unroofing technique, endoscopic mucosal resection (EMR), EMR after precutting (EMR-P), and endoscopic submucosal dissection (ESD). RESULTS Of 28 GI lipomas, 5 were located in the stomach, 2 in the duodenum, and 21 in the colon. Thirteen lipomas were <2 cm in diameter (small lipoma), and the other 15 were ≥2 cm (large lipoma). The unroofing technique was performed in 2 cases, EMR in 17 cases, EMR-P in 4 cases, and ESD in 5 cases. En bloc resection was performed with 21 lesions (75 %), and endoscopic complete resection was achieved with 26 lesions (93 %). Incomplete resection occurred in the 2 cases treated by the unroofing technique. On pathologic examination, complete resection was achieved with 21 lesions (75 %). Delayed bleeding was observed in one patient. There were no serious complications such as perforation or post-procedural stricture. During the mean follow-up period of 19 months (range 2-91 months), no recurrence was observed. CONCLUSIONS Endoscopic treatment appears to be a safe and effective treatment for GI lipomas, including large lipomas (≥2 cm in diameter).
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Affiliation(s)
- Kwang Jae Lee
- Department of Internal Medicine, Pusan National University School of Medicine, 1-10, Ami-dong, Seo-gu, Pusan, 602-739, Korea
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30
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Lee CS, Lee MJ, Kim KL, Kim YS, Baik GH, Kim JB, Kim DJ, Han SH. A case of giant lipoma causing chronic recurrent intussusception of the colon. Clin Endosc 2012; 45:165-8. [PMID: 22866259 PMCID: PMC3401622 DOI: 10.5946/ce.2012.45.2.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 03/19/2012] [Accepted: 03/22/2012] [Indexed: 11/18/2022] Open
Abstract
Colonic lipomas, which often occur in elderly women, usually have small size and occur mainly in the cecum and ascending colon. Most colonic lipomas are asymptomatic and identified incidentally at the time of endoscopy or surgery. However, they may cause symptoms such as bleeding, obstruction or intussusception as their size increases. Intermittent episodes of intussusception are uncommon but may be caused by large pedunculated lipoma. In a 68-year-old woman suffering intermittent abdominal pain, 5.5×4.5×3.8-cm huge mass was found by colonoscopy at proximal ascending colon, which was intussuscepted to proximal transverse colon on abdominal computed tomography. Segmental right colonic resection was conducted. We report a case of symptomatic giant pedunculated colonic lipoma causing intussusception requiring surgical intervention, with a successful recovery after surgery.
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Affiliation(s)
- Chang Seob Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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31
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Jeong TG, Choi SC, Seo GS. [Colocolic intussusception caused by lipoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:386-8. [PMID: 22783563 DOI: 10.4166/kjg.2012.59.5.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Taek Geun Jeong
- Department of Gastroenterology and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea
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32
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Alkhatib AA, Faigel DO. Endoscopic ultrasonography-guided diagnosis of subepithelial tumors. Gastrointest Endosc Clin N Am 2012; 22:187-205, vii. [PMID: 22632943 DOI: 10.1016/j.giec.2012.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Subepithelial lesions are frequently discovered during routine endoscopic examinations. These lesions represent a wide spectrum of heterogeneous benign to malignant conditions. Most of these lesions are asymptomatic. There is no consensus regarding how to manage these lesions. Over the last 2 decades, the approach to these lesions has significantly improved owing to the introduction of endoscopic ultrasonography, fine-needle aspiration, immunohistochemical staining methods, and different treatment options. This article discusses the nature of subepithelial lesions, focusing on the most recent developments that use endoscopic ultrasonography to diagnose and manage these lesions.
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Affiliation(s)
- Amer A Alkhatib
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Shuo Z, Bin L. Jejunal lipoma concealing intestinal adenocarcinoma: don't always regard CT imaging features like lipoma as benign or pseudomalignant features. Intern Med 2012; 51:181-4. [PMID: 22246487 DOI: 10.2169/internalmedicine.51.6497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lipomas are benign submucosal tumors composed of mature adipose tissue. Some authors have described patients with persistent abdominal pain who were misdiagnosed as intestinal adenocarcinoma and the diagnosis turned out to be a lipoma on histological examination. We discuss the case of a 57-year-old woman presenting with abdominal pain for 4 weeks. Intestinal adenocarcinoma was found by double-balloon enteroscopy (DBE), but at first only lipoma was found by CT scan. Therefore we want to emphasize that lipoma should not always be regarded as pseudomalignant features, sometimes lipoma conceals intestinal adenocarcinoma, and DBE may be a better way to discover malignancy.
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Affiliation(s)
- Zhang Shuo
- Department of Gastroenterology, Zhejiang Chinese Medicine University, China
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34
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Cao D, Sun X, Du J, Sun Y. Duodenal lipoma associated with ectopic duodenal glands. Clin Pract 2011; 1:e128. [PMID: 24765369 PMCID: PMC3981435 DOI: 10.4081/cp.2011.e128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 10/06/2011] [Accepted: 11/17/2011] [Indexed: 01/03/2023] Open
Abstract
Duodenal lipomas are relatively uncommon and are rarely responsible for clinical symptoms. Occasionally, searching for aetiology of gastrointestinal bleeding leads to the final diagnosis of duodenal lipomas. Here, we present the case of a 68-year-old woman who suffered with repeated melena and weight loss. Endoscopy, abdominal computed tomography (CT) and histopathological outcomes are described in this case of duodenal lipoma with ectopic duodenal glands.
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Affiliation(s)
- Dianbo Cao
- Department of Radiology, The First Hospital of Jilin University
| | - Xiaoyan Sun
- Department of Radiology, The First Hospital of Jilin University
| | - Jimin Du
- Department of Radiology, The First Hospital of Jilin University
| | - Yutian Sun
- Department of Pharmacy, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, PR of China
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35
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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: 0.7] [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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36
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Ouwerkerk HM, Raber, Freling G, Klaase JM. Duodenal Lipoma as a Rare Cause of Upper Gastrointestinal Bleeding. Gastroenterology Res 2010; 3:290-292. [PMID: 27942311 PMCID: PMC5139859 DOI: 10.4021/gr260w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2010] [Indexed: 12/24/2022] Open
Abstract
A 52-year-old female was referred because of melaena. After initital work-up, including gastroduodenoscopy, endosonography and CT scan, a duodenotomy was performed. Definite diagnosis was a duodenal lipoma based on histological findings. Lipomas of the gastrointestinal tract are rare. Only 4% occur in the duodenum. The peak incidence is around the 5th and 7th decade of life, with a slight female preponderance. Gastrointestinal lipomas are usually asymptomatic, but can present with mild to severe gastrointestinal bleeding, intussusceptions, abdominal pain, constipation and diarrhea. Clinical, endoscopical, surgical, and radiological features are described in this case of duodenal lipoma.
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Affiliation(s)
- Helga M Ouwerkerk
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Raber
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - G Freling
- Department of Pathology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J M Klaase
- Department of General Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
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37
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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:e49-50. [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] [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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38
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Morimoto T, Fu KI, Konuma H, Izumi Y, Matsuyama S, Ogura K, Miyazaki A, Watanabe S. Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection. World J Gastroenterol 2010; 16:1676-9. [PMID: 20355250 PMCID: PMC2848380 DOI: 10.3748/wjg.v16.i13.1676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old man presenting with hematochezia. Colonoscopy showed a submucosal tumor, about 50 mm in size, in the terminal ileum. A clinical diagnosis of lipoma was established based on the findings of colonoscopy and abdominal computed tomography (CT). As the patient complained of hematochezia and mild iron deficiency anemia associated with repeated tumor prolapse, we decided to remove his lipoma. Consequently, the lesion was completely removed en bloc. Although abdominal CT immediately after removal of the lesion showed a small amount of free air, conservative treatment was successfully carried out for the perforation. Histologically, the removed lesion was a lipoma.
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39
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Giant ulcerated lipoma of the colon causing iron deficiency anemia successfully treated with endoscopic ultrasound-assisted resection. South Med J 2009; 102:1058-60. [PMID: 19738527 DOI: 10.1097/smj.0b013e3181b6228b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.
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40
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Boyce S, Khor YP. A colonic submucosal lipoma presenting with recurrent intestinal obstruction attacks. BMJ Case Rep 2009; 2009:bcr11.2008.1199. [PMID: 21686420 DOI: 10.1136/bcr.11.2008.1199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Colonic submucosal lipomas are rare benign tumours of the colon, which may be discovered incidentally at colonoscopy, through imaging such as CT or at autopsy. These tumours can cause complications such as bleeding, intussusception and bowel obstruction. We describe the case of a patient in whom a small submucosal lipoma was identified at the time of colonoscopy and who did not receive follow-up treatment. The patient presented 1 year later with intussusception and obstruction resulting from this polyp and required urgent surgery. With the increasing use of colonoscopy and CT, such lesions are likely to be discovered more often. As complications can ensue, guidelines should be developed to advise on the management of such polyps in order to prevent consequent complications.
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Affiliation(s)
- Stephen Boyce
- Western General Hospital, Colorectal Unit, Crewe Road South, Edinburgh, EH4 2XU, UK
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41
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Chou JW, Feng CL, Lai HC, Tsai CC, Chen SH, Hsu CH, Cheng KS, Peng CY, Chung PK. Obscure gastrointestinal bleeding caused by small bowel lipoma. Intern Med 2008; 47:1601-3. [PMID: 18797119 DOI: 10.2169/internalmedicine.47.0963] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Obscure gastrointestinal bleeding is a very rare entity which accounts for less than 5% of all gastrointestinal bleeding cases. Small bowel tumors are rare but a serious source of obscure gastrointestinal bleeding. Lipomas are the second most common benign tumors in the small bowel and can produce many complications, including gastrointestinal bleeding. Herein, we describe a case of obscure gastrointestinal bleeding caused by a small bowel tumor which was detected by capsule endoscopy and double-balloon enteroscopy preoperatively. Finally, the tumor was surgically confirmed to be a lipoma.
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Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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42
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Twigt BA, Nagesser SK, Sonneveld DJA. Colo-colonic intussusception caused by a submucosal lipoma: case report and review of the literature. Case Rep Gastroenterol 2007; 1:168-73. [PMID: 21487564 PMCID: PMC3073806 DOI: 10.1159/000112651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Adult intussusception is a rare clinical presentation and often not considered clinically in the differential diagnosis of adult patients with vague abdominal complaints. A 44-year-old woman visited our emergency department with sudden onset of intermittent abdominal pain. Diagnostic imaging revealed an intussusception caused by a submucosal lipoma of the sigmoid. A laparotomy was performed and the diagnosis was proven by histological examination. Submucosal lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain and thus mimic a malignancy. Surgical excision is indicated for symptomatic cases.
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Affiliation(s)
- B A Twigt
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
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43
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Gürses B, Kabakci N, Akyuz U, Pata C, Taviloglu K, Kovanlikaya I. Imaging features of a cecal lipoma as a lead point for colo-colonic intussusception. Emerg Radiol 2007; 15:133-6. [PMID: 17704958 DOI: 10.1007/s10140-007-0641-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 05/29/2007] [Indexed: 11/25/2022]
Abstract
Intussusception is a rare occurrence in the adult population with most of the cases seen during the childhood period. Compared with the pediatric intussusceptions, there is more often an underlying cause in adults. Lipoma as a lead point for colonic intussusception is rare. Ultrasound may be helpful in the diagnosis, but computed tomography is more reliably used for differential diagnosis. An adult patient with colo-colonic intussusception diganosed with ultrasound and confirmed with computed tomography is presented.
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Affiliation(s)
- B Gürses
- Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey.
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