A case of gastroduodenal lipomatosis

Abstract

Although sporadic lipomas are not uncommon in the upper gastrointestinal tract, diffuse gastroduodenal lipomatosis is a rare clinical entity. Medical literature reveals a limited number of such cases presenting with upper gastrointestinal obstruction or bleeding. We present the management experience of a 43-year-old woman who presented with intussusception causing high small-bowel obstruction secondary to jejunal lipomatosis. Computed tomography showed diffuse fatty thickening of the gastric wall in addition to multiple lipomas in stomach, duodenum and in the jejunum with jejunal intussusception. As complete resection of the affected segment was not possible, a side-to-side jejunal bypass was made. The patient remains well on review after 18 months.

Keywords: Intussusception; Lipoma.

Figure 1

Coronal computed tomography reformat showing dilated duodenum and proximal jejunum with submucosal lipomas projecting into the fluid filled lumen (white arrows); fat in the wall of the gastric fundus (Gf) can also be appreciated in the upper left abdomen; just lateral to the DJ flexure (DJf) is the lipomatous jejunal intussusception (outline arrow)

Figure 2

Coronal computed tomography reformat showing gross fatty infiltration of the stomach wall (white arrows) around the distended, fluid filled lumen; two discrete lipomas can be appreciated in the fundus (black arrows)

Figure 3

A jejunal lipoma biopsied at the enterotomy