A Rare Case of Gastric Lipoma Presenting with Gastric Outlet Obstruction Treated Endoscopically

Abstract

An 85-year-old male referred to the Gastroenterology (GI) clinic with three-month history of failure to thrive and three-week history of nausea, vomiting, and melanotic stools. Ulcerative mass obstructing gastric outlet was found on endoscopy and on follow-up CT abdomen a homogeneous submucosal mass in the gastric antrum was identified. Radiological diagnosis of giant gastric lipoma was established and patient was evaluated for surgery and, however, was rendered unfit for surgery due to his comorbid conditions. Patient was taken for endoscopic resection of the mass. On endoscopy, only partial resection was achieved due to the size of the mass, but endoloops were deployed at the stalk at the end of the procedure in hope of limiting blood supply to the lesion. On six-week follow-up endoscopy, patient's mass had completely disappeared with limited scar tissue at the site.

Gastrointestinal bleeding as an initial manifestation of gastric lipoma: Case report and review of the literature

“…Gastric lipoma has a low risk of malignant transformation, and therefore, when it is asymptomatic, it requires neither resection nor surveillance 3 . Rarely, large gastric lipoma (>4 cm) can cause bleeding due to mucosal erosion or gastric outlet obstruction 1,2 . In a series of 32 patients with giant gastric lipoma, the main risk factor of bleeding was an ulcer overlying the lipoma 6 .…”

“…The tumor is generally asymptomatic, fortuitously found during the endoscopic or radiological examination. 1,3 The differential diagnosis includes other submucosal gastric tumors: stromal tumor, liposarcoma, fibroma, or a glomus tumor. The diagnosis is made by endoscopy and radiology.…”

“…3 Rarely, large gastric lipoma (>4 cm) can cause bleeding due to mucosal erosion or gastric outlet obstruction. 1,2 In a series of 32 patients with giant gastric lipoma, the main risk factor of bleeding was an F I G U R E 1 Endoscopic view: submucosal antral lesion of 4 cm F I G U R E 2 CT scan: The tumor is hypodense and heterogeneous ulcer overlying the lipoma. 6 The lipoma can ulcer because of venous stasis, friction, and trauma of the lipoma against the contralateral gastric wall.…”

“…The main location of the gastric lipoma was the antrum. 1,2,6,[13][14][15] The mean size of the lesion was 6.8 cm. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Eleven patients underwent surgical resection, and 5 patients underwent endoscopic resection.…”

“…It is generally asymptomatic, fortuitously discovered during the endoscopic or radiological examination. Rarely, it can cause bleeding due to mucosal erosion, gastric outlet obstruction, or gastroduodenal intussusception 1,2 . A case of gastric lipoma presenting with gastrointestinal bleeding is presented with a short review of the literature.…”