Work

Pylorus-spanning diffuse gastric lipomatosis as an uncommon cause of intermittent gastric outlet obstruction: a case report

Year: 2026

Type: article

Abstract: Introduction and importance: Gastric lipomas are uncommon; diffuse gastric lipomatosis is rarer, and pyloric involvement may cause bleeding or intermittent gastric outlet obstruction. We report a pylorus-spanning lipomatosis treated definitively by laparoscopic distal gastrectomy. Presentation of case: A 75-year-old man presented with melaena and post-prandial epigastric discomfort. Endoscopy revealed a broad-based submucosal mass at the pyloric canal intermittently prolapsing into the duodenal bulb with a small healing ulcer. computed tomography (CT) showed an 8.1 × 2.7 × 3.8 cm multiseptated fat-density mass traversing the pylorus with luminal narrowing. Positron emission tomography-CT demonstrated no abnormal hypermetabolism. Because of recurrent symptoms and trans-pyloric extension, laparoscopic distal gastrectomy with Billroth II reconstruction was performed. Histopathology confirmed diffuse lipomatosis of mature adipocytes without atypia. Recovery was uneventful; 1-month and 2-year imaging showed durable patency without recurrence. Clinical discussion: Gastric lipomatosis is rare. Treatment options include endoscopic submucosal dissection and laparoscopic-endoscopic cooperative approaches such as laparoscopic-endoscopic cooperative surgery, non-exposure endoscopic-laparoscopic cooperative surgery (NEWS), and CLEAN-NET (combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique). In pylorus-spanning diffuse lipomatosis, however, distal gastrectomy remains among the most reliable strategies for definitive symptom control. Conclusion: In symptomatic, pylorus-spanning gastric lipomatosis, laparoscopic distal gastrectomy offered dependable, durable relief of obstruction.

Source: International Journal of Surgery Case Reports

DOI: 10.1097/rc9.0000000000000278

Author: Kyeong Woon Choi

Institutions: Inje University, Inje University Ilsan Paik Hospital

Language: English

Topic: Gastrointestinal Tumor Research and Treatment

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090