Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & EMBASE  
     Home | Subscribe | Feedback  

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

Gastric lipoma presenting as obstruction and hematemesis.

RS Bijlani, VM Kulkarni, RB Shahani, HK Shah, A Dalvi, AB Samsi 
 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.

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.



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;39:42-3


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 2021 Apr 20 ];39:42-3
Available from: https://www.jpgmonline.com/text.asp?1993/39/1/42/648


Full Text




  ::   IntroductionTop


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 reportTop


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'.


  ::   DiscussionTop


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].


  ::   AcknowledgmentTop


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

References

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.
2Kang 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.
3Heiken JP, Forde KA, Golde RP. Computerised tomography as a definitive method of diagnosing gastrointestinal lipomas. Radiology 1982; 142:409-413.
4Ackerman NB, Chughtai SQ. Symptomatic lipomas of the gastrointestinal tract. Surg Gynaecol Obstet 1975; 145:565-568.
5Dragomireseu C, Tratea L, Tasca C, Roman S. A voluminous gastric lipoma simulating mediogastric stenosis. Rev Chir (Chir) 1990; 38:57-62 (English abstract).
6Lopez JI, Nevado M. Gastric Liporna and upper gastrointestinal haemorrhage. J Chir (Paris) 1990; 127:175-176.
7McCombe AW, Orr JD. Gastric lipoma and intussusception in a child. Scott Med J 1988; 33:310-311.
8Debeeer RA, Shinya H. Colonic lipomas. Gastrointest Endoscopy 1975; 22:90-91.
9Megibow A, Redmond PE, Bosniak MA, Horowitz L. Diagnosis of gastrointestinal lipomas by computerised tomography. Am J Radiol 1979; 133:743-745.

 
Tuesday, April 20, 2021
 Site Map | Home | Contact Us | Feedback | Copyright  and disclaimer