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

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.