Easton Hospital, Department of Surgery, Drexel University College of Medicine, Easton, Pennsylvania, USA (all authors).

ABSTRACT

Introduction: Lipomas of the intestinal tract are rare, but they present as the third most common cause of intestinal neoplasms. Most intestinal lipomas are asymptomatic. However, they may present with bleeding, obstruction, intussusception, or abdominal pain. Spontaneous expulsion of an intestinal lipoma is extremely rare and has never been reported in the postoperative period.

Case Description: We present the case of a 53-year-old male patient who underwent laparoscopic roux-en-Y gastric bypass. On postoperative day 4, the patient had a myocardial infarction and persistent abdominal discomfort. The spontaneous expulsion of an intestinal lipoma was observed on postoperative day 5, after which the patient instantly felt relief. In this case report, we provide a comprehensive literature review of intestinal lipomas, with their complications and management.

Discussion: Only a few spontaneous expulsions of intestinal lipomas have been described in the literature. This is the first reported case of a spontaneous expulsion in the immediate postoperative period or after a myocardial infarction. Intestinal lipomas may cause a variety of complications, including bleeding, obstruction, and intussusception. The likelihood of complications increases with size. The criteria for resection remain controversial, and a variety of technical methods have been described. Spontaneous rectal expulsion of giant intestinal lipomas without surgical or endoscopic manipulation is possible.

Conclusion: Intestinal lipomas are rare and either are asymptomatic or present with unspecific symptoms. A consensus on the clinical management of intestinal lipomas has not been established. Besides open surgery, laparoscopic and endoscopic treatment options are emerging.

Key Words: Lipoma, Laparoscopy, Postoperative complications, Intestinal diseases, Abdominal pain.

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Department of General Surgery, Easton Hospital, Easton, PA, USA (Drs. Baccaro, Ogu, Ibrahim, and Kohli). Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA (Dr. Vunnamadala).

ABSTRACT

Introduction: Morbid obesity is an growing problem in the United States. As the incidence of morbid obesity increases, so does the number of surgical procedures for weight loss. Surgeons must learn to manage common complications of these procedures.

Case Descriptions and Operative Technique: We present two cases of massive upper gastrointestinal hemorrhage secondary to marginal ulcers eroding into the left gastric artery. A novel surgical technique has been described from these experiences to deal quickly with this highly fatal complication.

Discussion: General surgeons must be aware of the altered anatomy and physiology because they will encounter these patients in the emergency setting. It is important to be familiar with common complications, know how to identify them in a timely manner, and treat them accordingly. Marginal ulcers are frequent; however, torrential hemorrhage secondary to these is less common and extremely lethal.

Key Words: Laparoscopic Roux-en-Y gastric bypass, Marginal ulcer after gastric bypass, Gastrointestinal bleeding, Surgical technique, Emergency surgery.

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