Incidental giant obstructed pedunculated gastric lipoma during gastrostomy: A case report

BACKGROUND: Most gastric lipomas are small, asymptomatic, and detected as incidental findings on radiologic evaluation or endoscopic examination of the upper gastrointestinal tract. We report a large lipoma which was noticed by its mass effect during a percutaneous endoscopic gastrostomy; the full evaluation prevented an unexplained failed procedure. PRESENTATION: A 65 year old man with a cerebrovascular accident (CVA) suffered from resistant vomiting and severe dysphagia. An endoscopic gastrostomy was indicated, but an incidental pedunculated submucosal mass in antrum terminated the procedure for further investigations, it was highly expected to cause an intermittent gastric outlet obstruction shortly after the procedure. The radiological evaluation found an 8 × 5 cm(2) lipoma. A resectional surgery was performed and combined with an open gastrostomy tube placement. DISCUSSION: Gastric lipoma is a very rare condition and mostly small and asymptomatic. Symptomatic ones could manifest by bleeding or obstruction. In our case, the obstruction was discovered incidentally by endoscopy. Computed tomography (CT) scan is an excellent diagnostic tool that confirmed the diagnosis. The treatment options range from open surgery to laparoscopic or endoscopic intervention. CONCLUSION: A full endoscopic evaluation for the upper gastrointestinal tract is recommended before gastrostomy. Our reported case gives an advantage of the percutaneous endoscopic gastrostomy procedure over the open gastrostomy tube placement to rule out a large asymptomatic gastric lipoma.