Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 5906  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (11 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  Acknowledgment
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed5768    
    Printed135    
    Emailed1    
    PDF Downloaded120    
    Comments [Add]    
    Cited by others 7    

Recommend this journal


 


 
CASE REPORTS
Year : 1993  |  Volume : 39  |  Issue : 1  |  Page : 42-3

Gastric lipoma presenting as obstruction and hematemesis.


Dept of Surgery, KEM Hospital and Seth GS Medical College, Parel, Bombay, Maharashtra.

Correspondence Address:
R S Bijlani
Dept of Surgery, KEM Hospital and Seth GS Medical College, Parel, Bombay, Maharashtra.

Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 0008295149

Rights and PermissionsRights and Permissions


 :: Abstract 

A rare case of gastric lipoma presented to us with hematemesis and symptoms of obstruction. On oesophagoduodenoscopy, a mass projecting in the lumen of stomach was found. Barium meal examination revealed a mass in the antral region suggestive of malignancy. The diagnosis of lipoma was suspected only after exploration. It was confirmed following incision through the serosa. The lipoma was enucleated without any damage to mucosa.


Keywords: Aged, Case Report, Gastric Outlet Obstruction, etiology,Hematemesis, etiology,Human, Lipoma, complications,Male, Stomach Neoplasms, complications,


How to cite this article:
Bijlani R S, Kulkarni V M, Shahani R B, Shah H K, Dalvi A, Samsi A B. Gastric lipoma presenting as obstruction and hematemesis. J Postgrad Med 1993;39:42

How to cite this URL:
Bijlani R S, Kulkarni V M, Shahani R B, Shah H K, Dalvi A, Samsi A B. Gastric lipoma presenting as obstruction and hematemesis. J Postgrad Med [serial online] 1993 [cited 2019 Nov 13];39:42. Available from: http://www.jpgmonline.com/text.asp?1993/39/1/42/648





  ::   Introduction Top


Lipomas of the gastrointestinal tract are rare; gastric lipomas account for only 5% of all gastrointestinal lipomas. The rarity of this condition prompts us to report our experience with a patient who presented with symptoms of obstruction and hematemesis and was diagnosed to have a gastric lipoma at exploration.


  ::   Case report Top


Mr. GV, a 70-year-old male patient presented to us with history of two bouts of hematemesis without malena. Both the bouts were small and were treated with antacids by a private practitioner. He had a history suggestive of gastric outlet obstruction since two months. There was no specific history of loss of weight or appetite. The patient was a non-alcoholic and had no history of jaundice in the past. General examination revealed pallor and the systemic examination was normal.

Biochemical investigations were normal except for a low haemoglobin value (7.0 gm%). Oesphago-gastro-duodenoscopy revealed the presence of a mass projecting into the lumen of the stomach at the level of antrum. The endoscope (Olympus IT10) could not be negotiated beyond the mass. The mucosa at and proximal to the obstruction was normal. A tentative diagnosis of a submucosal tumor was made. A biopsy obtained using the well technique was normal. Barium studies of the stomach and duodenum revealed a space occupying lesion in the antrum suggestive of malignancy [Figure - 1]. Abdominal sonography was normal.

At exploration, through an upper midline incision, a soft yellowish mass was seen in the antrum stretching the serosa upto the body of the stomach. The suspected diagnosis of lipoma was confirmed on incision through the serosa. The lipoma (7 x 6 cm) was easily enucleated without damage to the mucosa. The serosa was closed. Postoperative recovery was uneventful. The patient is asymptomatic at 6 months[1] follow-up'.


  ::   Discussion Top


Lipomas of the gastrointestinal tract are rare (1:600 necropsies[1]); the commonest site being the colon followed by the small intestine[2]. Gastric lipomas are extremely rare with an incidence of 5% of all the gastrointestinal lipomas and have an incidence of 3% of all benign tumours of the stomach[3]. The peak incidence is in the seventh decade 2 as seen in our case.

Gastric lipomas, usually asymptomatic, may present with abdominal pain, symptoms of obstruction and bleeding[4],[5],[6]. Pain is commonly due to mucosal ulceration and rarely due to intussusception[7]. Bleeding as in our case is usually mild and can lead to chronic anemia[4].

Barium studies show a mass effect, distortion of lumen, mucosal irregularity, which can be readily mistaken for malignancy especially in the elderly. A “squeeze sign” has been described[1] to diagnose lipomas where change in contour and configuration is seen during peristalsis on fluoroscopy. Endoscopy reveals a space occupying lesion with a normal overlying mucosa. “Cushion Sign” and “Ienting sign” are described[8] on endoscopy to diagnose this condition. Computerized tomography[9] is helpful in diagnosis due to low attenuation value of fat but may be difficult to differentiate from liposarcoma.

The treatment of gastric lipomas is undergoing a change since resection was advised by Ackerman and Chughtai[4] in 1975. Pre-operative diagnosis with the aid of CT scan can change the treatment pattern from mere observation in the asymptomatic to resection in symptomatic cases. Endoscopic removal is an alternative in pedunculated tumours[2].


  ::   Acknowledgment Top


We thank Dr (Mrs) PM Pai, Dean, Seth GS Medical College and Hospital, Mumbai for allowing us to present the hospital data.

 
 :: References Top

1. Hurwitz MM, Redleaf PD, Williams HJ, Edwards JE. Lipomas of the gastrointestinal tract. An analysis of 72 cases. Am J Radiol 1967; 99:840-849.  Back to cited text no. 1    
2.Kang JY, Chan-Wilde C, Wee A, Chu R, TI TK. Role of computerised tomography and endoscopy in the management of alimentary tract lipomas. Gut 1990; 31:550-553.  Back to cited text no. 2    
3.Heiken JP, Forde KA, Golde RP. Computerised tomography as a definitive method of diagnosing gastrointestinal lipomas. Radiology 1982; 142:409-413.  Back to cited text no. 3    
4.Ackerman NB, Chughtai SQ. Symptomatic lipomas of the gastrointestinal tract. Surg Gynaecol Obstet 1975; 145:565-568.  Back to cited text no. 4    
5.Dragomireseu C, Tratea L, Tasca C, Roman S. A voluminous gastric lipoma simulating mediogastric stenosis. Rev Chir (Chir) 1990; 38:57-62 (English abstract).  Back to cited text no. 5    
6.Lopez JI, Nevado M. Gastric Liporna and upper gastrointestinal haemorrhage. J Chir (Paris) 1990; 127:175-176.  Back to cited text no. 6    
7.McCombe AW, Orr JD. Gastric lipoma and intussusception in a child. Scott Med J 1988; 33:310-311.  Back to cited text no. 7    
8.Debeeer RA, Shinya H. Colonic lipomas. Gastrointest Endoscopy 1975; 22:90-91.  Back to cited text no. 8    
9.Megibow A, Redmond PE, Bosniak MA, Horowitz L. Diagnosis of gastrointestinal lipomas by computerised tomography. Am J Radiol 1979; 133:743-745.   Back to cited text no. 9    


    Figures

[Figure - 1]

This article has been cited by
1 Gastroduodenal intussusception secondary to a gastric lipoma
Vinces FY, Ciacci J, Sperling DC, et al.
CANADIAN JOURNAL OF GASTROENTEROLOGY. 2005; 19 (2): 107-108
[Pubmed]
2 Upper Gastrointestinal Stromal Tumors: Changes in Definition and Terms
Lunevicus R
Lithuanian Surgery. 2003; 1(1)
[Pubmed]
3 Gastric lipoma causing gastroduodenal intussusception
Sankaranunni, B., Ooi, D.S.W., Sircar, T., Smith, R.C., Barry, J.
International Journal of Clinical Practice. 2001; 55(10): 731-732
[Pubmed]
4 Gastric Lipoma Presenting As Gastrointestinal Bleeding: A Case Report
Alfred Ciraldo, David Thomas & Steven Schmidt
The Internet Journal of Oncology. 2000; 1(12)
[VIEW]
5 Gastric lipoma: A rare cause of gastrointestinal bleeding
Youssef PS, Wihelm LH, Schwesinger GO, et al.
SAUDI MEDICAL JOURNAL. 1999; 20 (11): 891-892
[Pubmed]
6 Gastric lipoma presenting as upper gastrointestinal obstruction
Treska VV, Pesek M, Kreuzberg B, et al.
JOURNAL OF GASTROENTEROLOGY. 1998; 33 (5): 716-719
[Pubmed]
7 Multiple gastric lipomas: Report of an asymptomatic case found at autopsy
Ventura L, Leocata P, Guadagni S, et al.
PATHOLOGY INTERNATIONAL. 1997; 47 (8): 575-577
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow