GIANT GASTRIC LIPOMA: A CASE REPORT AND LITERATURE REVIEW
DOI:
https://doi.org/10.34635/rpc.1016Keywords:
lipoma, stomach, surgery, laparoscopyAbstract
Introduction: Gastric lipomas are rare and defined as giant when they are greater than 4 cm, which is exceedingly rare. Most of them are asymptomatic; however, some symptoms may occur due to complications such as ulceration, digestive bleeding, or gastric obstruction.Case report: A 63-year-old male patient presented with early satiety, dyspepsia, and one episode of melena. Investigation revealed a ulcerated polypoid lesion, suggestive of a lipoma, in the antrum measuring approximately 7cm. The patient was discussed in a multidisciplinary meeting, and laparoscopic enucleation was proposed. The surgery and post-operative period were uneventful.
Literature review: A total of 40 surgically treated cases of giant gastric lipomas are reported in the literature. The average age at presentation is 55, and the most common symptoms are melena (56%), hematemesis (29%), and epigastric pain (29%). In more than half of the cases, an ulcer is present. On computed tomography, most lesions are well-defined, homogeneous, submucosal, and composed of fat, which is practically pathognomonic.
Discussion: This rare condition should be managed by a multidisciplinary team. We recommend endoscopic techniques for lesions up to 4cm and surgical management for larger lesions. Minimally invasive surgery should be preferred, and enucleation should be the standard procedure.
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References
1. Cappell MS et all. Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies. World J Gastroenterol 2017; 23(30): 5619-5633 DOI: 10.3748/wjg.v23.i30.5619
2. SalahTermos et all. Giant gastric lipoma presenting as GI bleed: Enucleation or Resection? International Journal of Surgery Case Reports 41 (2017) 39–42 doi: 10.1016/j.ijscr.2017.10.004
3. Stylianos Kapetanakis et all. A 20-year-old man with large gastric lipoma--imaging, clinical symptoms, pathological findings and surgical treatment. Folia Med (Plovdiv) 2010 Oct-Dec;52(4):67-70. doi: 10.2478/v10153-010-0020-3.
4. José Antonio Casimiro Pérez et all. Gastroduodenal invagination secondary to gastric submucosal lipoma treated by laparoscopic transgastric excision Cir Esp (Engl Ed). 2018 Apr;96(4):235. doi: 10.1016/j.ciresp.2017.09.003.
5. Julia R Amundson et all. Giant symptomatic gastric lipoma: A case report and literature review. Int J Surg Case Rep. 2018;51: 313-317. doi: 10.1016/j.ijscr.2018.08.061
6. Mohamad Emad Abdulrahman et all. Incidental giant obstructed pedunculated gastric lipoma during gastrostomy: A case report. Int J Surg Case Rep. 2018;53:433-435. doi: 10.1016/j.ijscr.2018.11.052.
7. Krishnaraj B et al. Gastric lipoma: a rare cause of haematemesis. Ann R Coll Surg Engl 2018;100:e41–3.
8. Rebeca Domínguez-Profeta et al. Laparoscopic sleeve gastrectomy for giant gastric lipoma in morbid obese patient. Cir Cir. 2020;88(Suppl 1):39-42. doi: 10.24875/CIRU.20001354
9. Seifollah Rezaii et al. Gastrointestinal bleeding due to gastrointestinal lipoma: A case report. Caspian J Intern Med. 2021 Autumn; 12(4): 622–625. doi: 10.22088/cjim.12.4.622
10. S Kumar et al. Gastric lipoma: a rare cause of massive haematemesis. Ann R Coll Surg Engl. 2021 Jun;103(6):e196-e198. doi: 10.1308/rcsann.2020.7094.
11. Lalanda R, Suárez González R. BMJ Case Rep 2021;14:e244686. doi:10.1136/bcr-2021-244686
12. Rafaela Parreira et al. Enucleation of a giant symptomatic gastric lipoma, a safe surgical approach. J Surg Case Rep. 2021 Mar; 2021(3): rjab087.doi: 10.1093/jscr/rjab087
13. Diego Rosales et al. Giant gastric lipoma as an uncommon cause of upper gastrointestinal bleeding. Rev Esp Enferm Dig. 2022 Feb;114(2):123-124. doi: 10.17235/reed.2021.8210/2021.
14. Giuseppe Grande et al. Too big to go out: gastric endoscopic submucosal dissection of giant lipoma complicated by intestinal obstruction. Endoscopy. 2021 Dec;53(12):E474-E475. doi: 10.1055/a-1346-8122
2. SalahTermos et all. Giant gastric lipoma presenting as GI bleed: Enucleation or Resection? International Journal of Surgery Case Reports 41 (2017) 39–42 doi: 10.1016/j.ijscr.2017.10.004
3. Stylianos Kapetanakis et all. A 20-year-old man with large gastric lipoma--imaging, clinical symptoms, pathological findings and surgical treatment. Folia Med (Plovdiv) 2010 Oct-Dec;52(4):67-70. doi: 10.2478/v10153-010-0020-3.
4. José Antonio Casimiro Pérez et all. Gastroduodenal invagination secondary to gastric submucosal lipoma treated by laparoscopic transgastric excision Cir Esp (Engl Ed). 2018 Apr;96(4):235. doi: 10.1016/j.ciresp.2017.09.003.
5. Julia R Amundson et all. Giant symptomatic gastric lipoma: A case report and literature review. Int J Surg Case Rep. 2018;51: 313-317. doi: 10.1016/j.ijscr.2018.08.061
6. Mohamad Emad Abdulrahman et all. Incidental giant obstructed pedunculated gastric lipoma during gastrostomy: A case report. Int J Surg Case Rep. 2018;53:433-435. doi: 10.1016/j.ijscr.2018.11.052.
7. Krishnaraj B et al. Gastric lipoma: a rare cause of haematemesis. Ann R Coll Surg Engl 2018;100:e41–3.
8. Rebeca Domínguez-Profeta et al. Laparoscopic sleeve gastrectomy for giant gastric lipoma in morbid obese patient. Cir Cir. 2020;88(Suppl 1):39-42. doi: 10.24875/CIRU.20001354
9. Seifollah Rezaii et al. Gastrointestinal bleeding due to gastrointestinal lipoma: A case report. Caspian J Intern Med. 2021 Autumn; 12(4): 622–625. doi: 10.22088/cjim.12.4.622
10. S Kumar et al. Gastric lipoma: a rare cause of massive haematemesis. Ann R Coll Surg Engl. 2021 Jun;103(6):e196-e198. doi: 10.1308/rcsann.2020.7094.
11. Lalanda R, Suárez González R. BMJ Case Rep 2021;14:e244686. doi:10.1136/bcr-2021-244686
12. Rafaela Parreira et al. Enucleation of a giant symptomatic gastric lipoma, a safe surgical approach. J Surg Case Rep. 2021 Mar; 2021(3): rjab087.doi: 10.1093/jscr/rjab087
13. Diego Rosales et al. Giant gastric lipoma as an uncommon cause of upper gastrointestinal bleeding. Rev Esp Enferm Dig. 2022 Feb;114(2):123-124. doi: 10.17235/reed.2021.8210/2021.
14. Giuseppe Grande et al. Too big to go out: gastric endoscopic submucosal dissection of giant lipoma complicated by intestinal obstruction. Endoscopy. 2021 Dec;53(12):E474-E475. doi: 10.1055/a-1346-8122
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Published
2024-01-11
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