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

• Published in: International journal of surgery case reports 2021-09, Vol.86, p.106366-106366, Article 106366
• Main Authors: Glosser, Logan D., Lombardi, Conner V., Knauss, Hanna M., Hopper, Wade, Alalwan, Abdullah, Stanek, Stephen
• Format: Article
• Language: English
• Subjects: Case Report; Constipation; Duodenal lipoma; Gastrointestinal tumors; Robotic surgery; Transverse duodenotomy
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106366

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. 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. 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. Clinicians should consider duodenal lipoma for patients with vague abdominal symptoms. We present a case of successful treatment with robotic-assisted transverse duodenotomy. •Only a few cases of symptomatic duodenal lipoma have been reported.•No specific treatment guidelines exist for duodenal lipomas.•First-reported treatment of duodenal lipoma via robotic-assisted transverse duodenotomy