P3233 - A Rare Case of a Large Duodenal Lipoma Resulting In Intussusception and Gastric Outlet Obstruction

Taher Jamali, MD¹, Faisal Nimri, MD², Yara JN. Dababneh, MD³, Palak Patel-Rodriguez, MD³, Syed Ahmad Adil, MD³, Kimberly Tosch, MD³, Muhammad Salman Faisal, MD³, Tobias Zuchelli, MD², Robert Pompa, MD^3
1Henry Ford Health, Farmington Hills, MI; ²Henry Ford Hospital, Detroit, MI; ³Henry Ford Health, Detroit, MI

Introduction: Duodenal lipomas are uncommon benign lesions containing fat cells, and the vast majority of cases are asymptomatic. Larger lesions can result in abdominal pain, gastrointestinal bleeding, and obstruction¹. Here, we report a rare case of a large duodenal lipoma that had resulted in intussusception and gastric outlet obstruction.

Case Description/Methods: A 45 year old male with progressive symptoms of poor oral intake, nausea, vomiting, and early satiety for a few months was referred to our center for further evaluation of a large submucosal lesion found on recent esophagogastroduodenoscopy (EGD). Repeat EGD revealed a large lesion protruding through the pylorus and extending into the duodenum to the level of the major papilla resulting in duodenal obstruction (Figure A). The length of this lesion was at least 6-7cm, and the stalk/base was wide (4-5cm). The major papilla was not involved. The patient was referred to surgical oncology outpatient, however he presented one month after initial endoscopy with gastrointestinal bleeding. Repeat EGD revealed the same gastroduodenal lesion with a small superficial ulcerated area and evidence of old blood. Bleeding resolved spontaneously, so no endoscopic treatment was performed. Given worsening symptoms of obstruction and bleeding, patient was evaluated for earlier surgery. He underwent distal gastrectomy with duodenal resection and Roux-en-Y gastrojejunostomy. He tolerated the procedure well and was discharged six days post-operatively with a full liquid diet. Surgical pathology (Figure B) revealed a submucosal lipoma with fat necrosis (9.4 cm in greatest dimension) and no evidence of dysplasia or malignancy.

Discussion: We present this case to highlight an extremely rare presentation of a large duodenal lipoma resulting in bleeding, intussusception, and gastric outlet obstruction. Initial diagnosis can be made with cross-sectional imaging, endoscopy, and/or endoscopic ultrasound. Although there are no clear guidelines for management of these lesions, endoscopic excision is usually favorable. However, for larger lesions, surgical excision may be the more optimal approach. Endoscopists should be aware of the endoscopic/endosonographic features, locations, and unique clinical presentations of these rare lesions.

References:

1. Pei MW et al. Diagnosis and Treatment of Duodenal Lipoma: A Systematic Review and a Case Report. J Clin Diagn Res. 2017;11(7):PE01-PE05. doi:10.7860/JCDR/2017/27748.10322



Disclosures:


Taher Jamali, MD¹, Faisal Nimri, MD², Yara JN. Dababneh, MD³, Palak Patel-Rodriguez, MD³, Syed Ahmad Adil, MD³, Kimberly Tosch, MD³, Muhammad Salman Faisal, MD³, Tobias Zuchelli, MD², Robert Pompa, MD³. P3233 - A Rare Case of a Large Duodenal Lipoma Resulting In Intussusception and Gastric Outlet Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.