Diagnosis and Treatment of Duodenal Lipoma: A Systematic Review and a Case Report

Abstract

Introduction: Duodenal lipoma is very rare with limited case reports present in literature. Owing to recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, no systematic study of duodenal lipomas has been reported.

Aim: To study the diagnosis and treatment of duodenal lipoma in a female patient and review the relative literatures to enhance the knowledge of it.

Materials and methods: A literature search for 'duodenal lipoma' was performed on PubMed. Papers published from 1948 to 2016 in the English language were identified. Each article was then read in detail and analysed for clinical data, imaging features, diagnosis and therapy. Also, we hereby present a case of upper gastrointestinal obstruction secondary to multiple duodenal lipomas in a 67-year-old woman. The patient underwent a limited bowel resection with an uneventful recovery.

Results: Literature review demonstrated 59 cases of duodenal lipoma, which indicate that duodenal lipomas are rare to occur but commonly found in the second part. The peak of incidence seems to be around the fifth and seventh decade of life. Duodenal lipomas may present as gastrointestinal bleeding, abdominal pain, obstruction or upper abdominal fullness. CT, MRI, Endoscopic Ultrasound (EUS), endoscopy are highly accurate diagnostic tools. The disease could be managed by endoscopy or surgery.

Conclusion: Our review of literature indicated duodenal lipoma is extremely rare. The symptoms are nonspecific and CT is the first choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour.

Keywords: Bleed; Duodenal neoplasm; Duodenectomy; Obstruction.

[Table/Fig-1]:

CT scan appearance of duodenal lipoma.

[Table/Fig-2]:

Axial T1-weighted MRI shows a well-demarcated, hyperintense mass (arrow).

[Table/Fig-3]:

MRI showing the lesions drop in signal on T1 -weighted fat-suppressed image.

[Table/Fig-4]:

Excised submucous, multiple lipomatosis showing naked fat sign.

[Table/Fig-5]:

Pathological report indicating duodenal lipoma originating in submucosal layer (H&E 4x).

[Table/Fig-6]:

Flow diagram of article selection for inclusion in this study. (on initial assessment all abstracts were in English but in six articles the full text was found to be in non-English).

[Table/Fig-8]:

Age distribution of patients with duodenal lipoma.

[Table/Fig-9]:

Location distribution of the tumour.

[Table/Fig-10]:

The diagnostic accuracy of each method.

[Table/Fig-11]:

Summary of the treatment.