Endoscopic diagnosis and treatment of a giant duodenal lipoma presenting with gastrointestinal bleeding
27 November 2013 (online)
A 66-year-old man presented with fatigue and acute upper gastrointestinal bleeding (hemoglobin 92 g/L). He had melena but no signs of hematemesis. Upper gastrointestinal endoscopy revealed a 35 × 15-mm large polypoid lesion with multiple ulcerations in the second part of the duodenum ([Fig. 1]). No biopsy samples were taken due to the risk of bleeding. The diagnosis was unclear and the patient underwent endoscopic ultrasound, which demonstrated a hyperechoic lesion measuring 11 × 19 mm in diameter in the submucosa in the duodenal wall with intact muscularis propria ([Fig. 2]), suggestive of a lipoma. A subsequent capsule endoscopy excluded distal causes of bleeding in the small intestine. Next, the lesion was removed endoscopically using an endoloop and snare without any complication ([Fig. 3]). The resected lesion exhibited multiple ulcerated areas ( [Fig.4]). Histological examination demonstrated a duodenal lipoma with large blood vessels in contact with these ulcerated areas ([Fig. 5]).
Duodenal lipomas are extremely rare and constitute only one in 600 benign tumors of the gastrointestinal tract . Duodenal lipomas are usually asymptomatic but larger ones can, in rare cases, cause abdominal pain, intestinal obstruction, or hemorrhage [2, 3]. Symptomatic duodenal lipomas should be removed. The current recommendation is endoscopic excision, unless this is technically difficult and warrants surgical excision. Nonetheless, this unusual case with a duodenal lipoma causing upper gastrointestinal bleeding underlines the clinical importance of endoscopic ultrasound in the workup of patients with unclear submucosal lesions in the gastrointestinal tract.
- 1 Mayo CW, Pagtaluman RJG, Brown DJ. Lipoma of the alimentary tract. Surgery 1963; 53: 598-603
- 2 Tung CF, Chow WK, Peng YC et al. Bleeding duodenal lipoma successfully treated with endoscopic polypectomy. Gastrointest Endosc 2001; 54: 116-117
- 3 Blanchet MC, Arnal E, Paparel P et al. Obstructive duodenal lipoma successfully treated by endoscopic polypectomy. Gastrointest Endosc 2003; 58: 938-939