Gastric Outlet Obstruction from Duodenal Lipoma in an Adult
A 40-year-old man presented to our institution with a 3 months history of projectile, copious vomiting (which consisted of recently ingested food), epigastric fullness, constipation and abdominal discomfort. There was no history of hematemesis, melena or change in bowel habit. He had a 7 months history of dyspepsia.\nClinical examination, showed a chronically ill-looking man, emaciated, pale and dehydrated. Visible peristalsis was noted at the upper abdomen with demonstrable succussion splash. He had no ascites, organomegaly or a palpable mass. Barium meal showed a dilated stomach with a large amount of residual food debris mixed with barium sulfate []. An extrinsic pressure effect was seen in the pyloric region of the stomach with resultant gastric outlet obstruction (GOO). The duodenum was not demonstrated. An abdominal ultrasound scan showed a large and prominent stomach, with the gastric lumen harboring large food debris with near absence of gastric emptying. An area of fusiform bowel thickening was noted near the duodenal bulb. He could not be investigated further due to financial constraints. We were, therefore left with no option than to carry out an exploratory laparotomy, after fluid and electrolyte resuscitation. The finding was a pedunculated, submucosal lipoma arising from the second part of the duodenum that extends to occlude the distal duodenum and proximal jejunum []. A duodenotomy with wedge resection of the pedunculated lipoma and primary repair was done. A sleeve of duodenal mucosa was taken along with the lipoma because of a suspicious nodule on the mucosa []. The post-operative course was uneventful and the patient was discharged home on the 7th day after the surgery. Final histopathological diagnosis of the specimen was a submucosal duodenal lipoma measuring 11 cm × 8 cm × 6 cm.