Gastric lipoma causing ball-valve syndrome successfully treated by endoscopic submucosal dissection.
Naoto Abe, Takuto Hikichi, Minami Hashimoto et al.
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Case in brief
A 52-year-old woman presented with postprandial epigastric discomfort and nausea. CT showed a low-attenuation mass extending from the gastric antrum to the duodenal bulb; endoscopy found a broad-based subepithelial lesion over 50 mm that prolapsed through the pylorus, causing ball-valve syndrome. Endoscopic ultrasound showed a homogeneous hyperechoic submucosal lesion, suggesting lipoma, although liposarcoma could not be excluded. Endoscopic submucosal dissection with clip-and-line traction achieved en bloc resection without adverse events. Histopathology confirmed a gastric lipoma. Symptoms resolved, with no recurrence at 1-year follow-up.
What made this case unusual
A large gastric lipoma causing intermittent gastric outlet obstruction was removed en bloc by endoscopic submucosal dissection, despite uncertainty about excluding liposarcoma before resection.
Diagnostic / clinical pearl
A mobile gastric subepithelial lesion that prolapses through the pylorus can cause ball-valve obstruction; imaging may suggest lipoma, but histopathology can be needed when liposarcoma cannot be excluded.
Why it matters
This case illustrates that endoscopic resection may be feasible for a large gastric lipoma causing ball-valve syndrome in a selected patient.