Gastric lipoma: a rare cause of massive haematemesis

Gastric lipomas are rare benign neoplasms of the stomach. These submucosal lesions and located mostly in the antral region of the stomach. Small lipomas are usually asymptomatic and are detected incidentally. When large, they may present with abdominal pain, gastrointestinal (GI) bleeding or gastric outlet obstruction. We hereby present a case of gastric lipoma in a 54-year-old man presenting with massive upper GI bleed and haemodynamic instability. The diagnosis was established with endoscopy and contrast-enhanced computed tomography of the abdomen. After resuscitation, the patient underwent laparoscopic resection of the antral lipoma.

Endoscopic resection of a large submucosal tumor causing intermittent gastric outlet obstruction using a novel radiofrequency enabled device

Gastric lipomas are rare benign tumors and account for 1-3% of all benign gastric tumors. Majority of the gastric lipomas are asymptomatic and do not demand resection. However, large gastric lipomas may present with upper gastrointestinal bleeding and more rarely gastric outlet obstruction. Traditionally, surgery has been utilized for the management of giant gastric lipomas. More recently, endoscopic techniques are increasingly utilized for the resection of gastric submucosal lesions. Here we describe a case with large gastric lipoma who presented with symptoms suggestive of gastric outlet obstruction. Gastroscopy revealed a large (6 cm) submucosal lesion with a broad peduncle located in antrum. The tumor was prolapsing into duodenum thereby, completing occluding the pylorus. In this case, we performed endoscopic submucosal dissection using a novel, bipolar radiofrequency device. The dissection was completed without any complication.

Enucleation of a giant symptomatic gastric lipoma, a safe surgical approach

Gastric lipomas are rare, representing 2–3% of all benign tumours of the stomach. Most of these stomach neoplasms are small and detected incidentally during endoscopic or radiology evaluations. Computed tomography is highly specific imaging for lipoma diagnosis. Endoscopy and endoscopic ultrasound are other important diagnostic modalities to confirm the diagnosis. Identifying typical features can avoid biopsy or surgery in asymptomatic patients. In patients with larger lesions, usually more than 2 cm, clinical presentation may encompass haemorrhage, abdominal pain, pyloric obstruction and dyspepsia. As a result of its extreme low incidence, treatment is not standardized, though it is widely accepted that a symptomatic tumour mandates resection. Here, we present the case of a 60-year-old female presenting with abdominal pain and recurrent vomiting due to a giant gastric lipoma (80 × 35 × 35 mm). The patient underwent laparotomy and an enucleation was performed.

Analysis of missed diagnosis of gastric lipomas by CT

Introduction: Although by Computed Tomography (CT) is the most convenient technology for the diagnosis of gastric lipoma, it also has a high rate of missed diagnosis of gastric lipoma. Objective: To analyze the causes of missed diagnosis of gastric lipomas by CT. Method: We retrospectively studied the CT images and CT diagnosis reports of 25 cases of gastric lipoma confirmed by surgery or clinical follow-up at the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital from 2016 to 2020, and analyzed the causes of missed diagnosis of gastric lipomas. Results: Among the 25 cases of gastric lipomas included in this study, 17 cases (68.0%) were correctly diagnosed by CT and 8 cases (32.0%) were missed, but there was no case of misdiagnosis. 18 cases (72.0%) of gastric lipomas were located in the gastric antrum, 2 cases (8.0%) at the junction of the gastric body and antrum, 5 cases (20.0%) at the fundus of the stomach, 23 cases (92.0%) under the gastric mucosa, and 2 cases (8.0 %) under the gastric serous membrane. All gastric lipoma cases were manifested as round or oval-shaped low-density shadows with clear boundaries on CT. 22 cases (88.0%) showed homogeneous low-density shadows while 3 cases (12.0%) mainly showed low-density shadows containing medium-density strips. There was no obvious enhancement in the contrast enhanced CT scan. The gastric lipoma cases missed by CT were all located under the gastric mucosa of the gastric antrum. When reading the CT images on the default upper abdominal window width and window level, all the missed lesions were similar to the gas image. And the straight meridian of three lesions was less than 2 cm. Conclusion: Fat density shadow in gastric antrum area mistaken for gastrointestinal gas. Improper CT image window width and window levels, and small gastric lipoma volume, along with insufficient knowledge of gastric lipomas imaging by the clinician might be the main causes of missed diagnosis of gastric lipomas by CT. Familiarity with the CT manifestations of gastric lipomas and rich clinical experience can improve the rate of correct diagnosis of gastric lipomas by CT.