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

Logan D Glosser,Hanna M Knauss,Wade Hopper,Conner V Lombardi,Stephen Stanek,Abdullah Alalwan

doi:10.1016/j.ijscr.2021.106366

Abstract

Introduction and importanceLipomas 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 presentationA 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 discussionThis 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.ConclusionClinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy.

Highlights

Introduction and importanceLipomas are the third most common benign tumor of the gastrointestinal (GI) tract, typically occurring in the colon or small intestine
We present a case from an academic hospital in which a patient with symptomatic duodenal lipoma was successfully treated with bowel-sparing robotic assisted laparoscopic transverse duodenotomy
A 53-year-old Caucasian non-obese female self-presented to the primary care provider (PCP) with a 1-year history of worsening con stipation and inability to tolerate food

Summary

Introduction

Duodenal lipomas are a rare benign tumor accounting for 4% of gastrointestinal lipomas. Duodenal lipomas are typically asymptomatic and often found incidentally [1]. With less than 100 cases of symptomatic duodenal lipomas reported, there is no standardized treatment [2]. Limited management approaches are documented in the literature, including endoscopic, laparoscopic, and open approaches to resection with duodenectomy or, more rarely, duodenotomy [2]. We present a case from an academic hospital in which a patient with symptomatic duodenal lipoma was successfully treated with bowel-sparing robotic assisted laparoscopic transverse duodenotomy. This case report has been reported in line with the SCARE Criteria [4]

Presentation of case

Discussion

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Ethical approval