Duodenal lipoma presenting with acute pancreatitis in a teenager: A case report

Introduction Duodenal lipomas are an uncommon pathology that can be discovered incidentally or present with an array of symptoms. They are rare in pediatric patients, with only limited case reports available. Case Presentation A 17-year-old female presented with a two-day history of epigastric abdominal pain and was found to have acute pancreatitis (lipase >3500 U/L). Magnetic resonance cholangiopancreatography demonstrated a clustered appearance of bowel in the left upper quadrant with displacement of the pancreatic head across midline into the left upper quadrant and dilation of the pancreatic and bile ducts. Computed tomography demonstrated a multilobulated lipomatous mass in the left upper quadrant, measuring up to 6.8 x 4.2 x 2.7 cm with resultant distortion of the surrounding and upstream bowel loops. Diagnostic laparoscopy revealed an intraluminal mass in the fourth portion of the duodenum intussuscepting into the proximal jejunum. After converting to a laparotomy, a longitudinal incision was made on the proximal jejunum and a trilobular submucosal mass was identified, which was anchored to the posterior submucosal layer of the fourth portion of the duodenum. After ensuring the ampulla was not involved, the mass was excised, the posterior mucosa closed, and the anterior enterotomy closed. Pathology demonstrated a lipoma. The post-operative course was uneventful and she was recovering well at her 19-day post-operative appointment. She has not had any complications to date at 6 months post-operatively. Conclusion Lipomas should be considered in the differential diagnosis of teenagers that present with acute pancreatitis and have duodenal lesions identified on preoperative imaging.