A Case of a Giant Lipoma of the Duodenal Bulb

Abstract

We describe a 58-year-old male whose major complaint was epigastric pain. A pediculate mass located in the anterior wall of the duodenal bulb and extending into the descending portion of the duodenum was noted on endoscopy of the upper digestive tract. The mass nearly completely occupied the duodenal lumen and was covered by normal mucosa with a tiny ulcer. Ultrasound endoscopy showed a nearly homogeneous hyperechoic pattern localized in the submucosa, and abdominal CT showed fatty density, suggesting a lipoma. The mass was resected by laparotomy, because it was large and extended to near the duodenal papillae. The tumor measured 55X35X30 mm and was histologically confirmed to be a lipoma which had originated in the submucosa. Giant duodenal lipomas more than 50 mm in maximum diameter have only been reported in 5 cases in Japan including our present case and 9 cases abroad, but some differences were observed in the description of the Japanese cases versus the nonJapanese cases, such as the fact that the non-Japanses cases often presented with severe symptoms such as bloody stools and intussusception. (Dig Endosc 1999; 11: 345-349)