Incidental duodenal leiomyoma discovered during robotic SADI: A case report of surgical adaptation and successful outcome.

INTRODUCTION AND

IMPORTANCE

Duodenal leiomyomas are rare, often asymptomatic benign tumors, typically discovered incidentally during surgery. This case highlights a unique leiomyoma found during robotic Single Anastomosis Duodeno-Ileal bypass (SADI), emphasizing the importance of intraoperative adaptability in bariatric surgery.

CASE PRESENTATION: A 56-year-old male with a BMI of 56 kg/m2 underwent robotic SADI. Despite unremarkable preoperative endoscopy, sutures cut through a thickened duodenal wall during duodeno-ileostomy, revealing a leiomyoma on frozen section biopsy. The duodenum and distal antrum were resected, and the procedure was converted to robotic mini gastric bypass (MGB).

CLINICAL DISCUSSION: This rare finding underscores the challenge of detecting submucosal lesions preoperatively and the need for rapid intraoperative decision-making. Conversion to MGB achieved 90 % excess weight loss at 1-year follow-up, with no malnutrition or complications, demonstrating effective adaptation.

CONCLUSION

Surgeons performing robotic bariatric procedures must be prepared to manage unexpected pathology through flexible surgical strategies, ensuring favorable outcomes.