Treatment of duodenal lipoma with robotic-assisted transverse duodenotomy: A case report of novel approach

Abstract

Introduction and importance: Lipomas are the third most common benign tumor of the gastrointestinal (GI) tract, typically occurring in the colon or small intestine. Less than 100 cases of symptomatic duodenal lipomas have been reported. Symptoms include non-specific upper GI complaints of heartburn, fullness, or abdominal pain. This report highlights the rarity of symptomatic duodenal lipomas, lack of specific treatment guidelines, and adds to surgical literature a new treatment approach.

Case presentation: A 53-year-old Caucasian woman presented with 2-year history with main concerns for early satiety and constipation. CT scan with contrast of the abdomen and pelvis demonstrated a duodenal mass. Differential diagnosis included duodenal lipoma versus stricture, and IBS. Subsequent EGD revealed a 4 cm transverse duodenal submucosal mass. Endoscopic removal was deemed too great a risk of bleeding. Pre-operatively, the patient expressed frustration as the patient was tolerating only a liquid diet with one bowel movement weekly. Treatment with robotic assisted transverse duodenotomy was performed, with final pathology of benign lipomatous tissue. Post-operatively the patient had immediate relief of symptoms which persisted at 2-week and 4-month follow-ups.

Clinical discussion: This case demonstrates 3 primary learning points. First, duodenal lipomas should be included in the differential of vague upper GI symptoms. Second, we propose that surgeons consider treatment of duodenal lipomas utilizing robotic assisted approach. Third, we document the first robotic-assisted transverse duodenotomy for duodenal lipomas.

Conclusion: Clinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy.

Keywords: Case report; Constipation; Duodenal lipoma; Gastrointestinal tumors; Robotic surgery; Transverse duodenotomy.

Fig. 1

Colonoscopy with removal of 3 sessile polyps 5–6 mm in size located in the rectum.

Fig. 2

CT scan revealing duodenal mass anterior to right kidney.

Fig. 3

CT scan: Enlarged gallbladder overlying duodenal lipoma.

Fig. 4

EGD: Large 4 cm submucosal mass in the third segment of the duodenum, D3.

Fig. 5

Patient timeline of events from initial encounter to final procedure.