Open Excision of a Broad-Based Duodenal Lipoma Not Amenable to Endoscopic Resection: A Case Report

Duodenal lipomas are rare, benign, fat-containing submucosal tumors that are usually silent but can cause bleeding, obstruction, or intussusception once they exceed 2 cm. We report the case of a 40-year-old man with hypertension who presented with postprandial colicky abdominal pain, recurrent melena, and a 10-kg weight loss, having restricted himself to a pureed-food diet for three months. Endoscopy showed a 4-5 cm, broad-based polyp obstructing 75% of the duodenal lumen at the distal first/proximal second portion; forceps biopsy showed only hyperplastic mucosa. Endoscopic ultrasound (EUS) and CT demonstrated a homogeneous, fat-density submucosal mass consistent with lipoma. Given its size and broad base, endoscopic resection was considered unsafe, and the lesion was excised through duodenotomy, preserving the ampulla, bile and pancreatic ducts, and duodenal wall. Histopathology confirmed a submucosal lipoma. The patient recovered uneventfully, with resolution of anemia and symptoms. This report highlights the importance of individualized decision-making when a duodenal lipoma is not amenable to endoscopic resection.