Blutender Stöpsel im Magenausgang – seltene Komplikation eines Riesenlipoms im Antrum

Zusammenfassung

Ein 67-jähriger Patient wurde mit Inappetenz und oberer gastrointestinaler Blutung stationär eingewiesen. Bei der umgehend durchgeführten Notfallgastroskopie zeigte sich als Blutungsquelle ein großer subepithelialer, exulzerierter Tumor im Magenantrum. Von der Tumorulzeration ausgehend ragte ein langer zapfenförmiger Auswuchs über den Pylorus bis ins Duodenum und verursachte hierdurch eine Magenausgangsstenose. Ausgehend von diesem ungewöhnlichen Fall wird ein Literaturüberblick über die Differenzialdiagnostik und Therapiemöglichkeiten gastrointestinaler Lipome gegeben.

Abstract

A 67-year-old patient was admitted to our hospital with lack of appetite and upper gastrointestinal bleeding. The immediately performed emergency gastroscopy showed a giant subepithelial tumour with ulceration located in the antrum. Emerging from the tumourous ulcer was a peg-shaped outgrowth reaching through the pylorus down to the duodenum causing gastric outlet obstruction. Based on this unusual presentation of a gastric giant lipoma we have reviewed the literature concerning differential diagnosis and treatment options.

Schlüsselwörter

gastrointestinale Blutung - obere gastrointestinale Blutung - gastrointestinaler Stromatumor (GIST)

Key words

gastrointestinal bleeding - upper gastrointestinal bleeding - gastrointestinal stromal tumour (GIST)

• Literatur

• 1 Atila K, Terzi C, Obuz F et al. Symptomatic intestinal lipomas requiring surgical interventions secondary to ileal intussusception and colonic obstruction: report of two cases. [Internet]. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 2007; 13: 227-231
• 2 Aydin HN, Bertin P, Singh K et al. Safe techniques for endoscopic resection of gastrointestinal lipomas. Surg Laparosc Endosc Percutan Tech 2011; 21 (04) 218-222
• 3 Bilgin M, Toprak H, Ahmad IC et al. Ileocecal Intussusception due to a Lipoma in an Adult. Case reports in surgery 2012; 2012: 684298
• 4 Cantor MJ, Davila RE, Faigel DO. Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection. Gastrointestinal endoscopy 2006; 64: 29-34
• 5 Düx M, Grenacher L, Lubienski A et al. Carcinoma of the stomach. Role of imaging for primary diagnosis and preoperative tumor staging. Fortschr Röntgenstr 2000; 172 (08) 661-669
• 6 Dultz LA, Ullery BW, Sun HH et al. Ileocecal valve lipoma with refractory hemorrhage. [Internet] JSLS: Journal of the Society of Laparoendoscopic Surgeons/Society of Laparoendoscopic Surgeons 2009; 13: 80-83
• 7 Fernandez MJ, Davis RP, Nora PF. Gastrointestinal lipomas. Arch Surg 1983 ; 118 (09) 1081-1083
• 8 Geraci G, Pisello F, Arnone E et al. Endoscopic Resection of a Large Colonic Lipoma: Case Report and Review of Literature. Case reports in gastroenterology 2010; 4: 6-11
• 9 Heye T, Kuntz C, Düx M et al. CT and endoscopic ultrasound in comparison to endoluminal MRI: preliminary results in staging gastric carcinoma. Eur J Radiol 2009; 70 (02) 336-341
• 10 Hunt GC, Smith PP, Faigel DO. Yield of tissue sampling for submucosal lesions evaluated by EUS. Gastrointestinal endoscopy 2003; 57: 68-72
• 11 Hwang JH, Saunders MD, Rulyak SJ et al. A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. [Internet]. Gastrointestinal endoscopy 2005; 62: 202-208
• 12 Krasniqi AS, Hoxha FT, Bicaj BX et al. Symptomatic subserosal gastric lipoma successfully treated with enucleation. [Internet] World journal of gastroenterology: WJG 2008; 14: 5930-5932
• 13 Lee CK, Chung IK, Lee SH et al. Endoscopic partial resection with the unroofing technique for reliable tissue diagnosis of upper GI subepithelial tumors originating from the muscularis propria on EUS (with video). Gastrointestinal endoscopy 2010; 71: 188-194
• 14 Lee CS, Lee MJ, Kim KL et al. A case of giant lipoma causing chronic recurrent intussusception of the colon. Clinical endoscopy 2012; 45: 165-168
• 15 Lee HL, Kwon OW, Lee KN et al. Endoscopic histologic diagnosis of gastric GI submucosal tumors via the endoscopic submucosal dissection technique. Gastrointestinal endoscopy 2011; 74: 693-695
• 16 Li QL, Yao LQ, Zhou PH et al. Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointestinal endoscopy 2012; 75: 1153-1158
• 17 Maderal F, Hunter F, Fuselier G et al. Gastric lipomas – an update of clinical presentation, diagnosis, and treatment. [Internet] The American journal of gastroenterology 1984; 79: 964-967
• 18 Mah YH, Huang SP, Chen JH et al. Gastric submucosal tumor removal. [Internet]. Gastrointestinal endoscopy 2005; 61: 290-291
• 19 Matsuki M, Gouda Y, Ando T et al. Adenocarcinoma arising from aberrant pancreas in the stomach. Journal of gastroenterology 2005; 40: 652-656
• 20 Minaya Bravo AM, Vera Mansilla C, Noguerales Fraguas F et al. Ileocolic intussusception due to giant ileal lipoma: Review of literature and report of a case. International journal of surgery case reports 2012; 3: 382-384
• 21 Morimoto T, Fu K-I, Konuma H et al. Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection. . [Internet]. World journal of gastroenterology: WJG 2010; 16: 1676-1679 . [cited 2013 Jun 6]
• 22 Nishiyama N, Mori H, Kobara H et al. Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection. World journal of gastroenterology: WJG 2013; 19: 2752-2760
• 23 Otani Y, Ohgami M, Igarashi N et al. Laparoscopic wedge resection of gastric submucosal tumors. [Internet]. Surgical laparoscopy, endoscopy & percutaneous techniques 2000; 10: 19-23
• 24 Park KJ, Lee MW, Koo JH et al. Detection of early gastric cancer using hydro-stomach CT: blinded vs unblinded analysis. World J Gastroenterol 2011; 17 (08) 1051-1057
• 25 Park SH, Han JK, Kim TK et al. Unusual gastric tumors: radiologic-pathologic correlation. [Internet]. Radiographics: a review publication of the Radiological Society of North America, Inc 1999; 19: 1435-1446
• 26 Pickhardt PJ, Kim DH, Menias CO et al. Evaluation of submucosal lesions of the large intestine: part 1. Neoplasms. Radiographics : a review publication of the Radiological Society of North America, Inc 2007; 27: 1681-1692
• 27 Rodriguez SA, Faigel DO. Endoscopic diagnosis of gastrointestinal stromal cell tumors. Current opinion in gastroenterology 2007; 23: 539-543
• 28 Taylor AJ, Stewart ET, Dodds WJ. Gastrointestinal lipomas: a radiologic and pathologic review. Am J Roentgenol American journal of roentgenology 1990; 155: 1205-1210
• 29 Treska V, Pesek M, Kreuzberg B et al. Gastric lipoma presenting as upper gastrointestinal obstruction. . [Internet] Journal of gastroenterology 1998; 33: 716-719 [cited 2013 Jun 6]
• 30 Vorbeck F, Osterreicher C, Püspök A et al. Comparison of spiral-computed tomography with water-filling of the stomach and endosonography for gastric lymphoma of mucosa-associated lymphoid tissue-type. Digestion 2002; 65 (04) 196-199
• 31 Yahagi N. Is esophageal endoscopic submucosal dissection an extreme treatment modality, or can it be a standard treatment modality?. Gastrointestinal endoscopy 2008; 68: 1073-1075
• 32 Yoshida T, Fujisaki J, Suganuma T et al. Successful en bloc resection of a 5 cm symptomatic sessile gastric lipoma by endoscopic submucosal dissection. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society 2012; 24: 282
• 33 Zak Y, Biagini B, Moore H et al. Submucosal resection of giant gastric lipoma. Journal of surgical oncology 2006; 94: 63-67