Clin Endosc.  2020 Mar;53(2):236-240. 10.5946/ce.2019.035.

A Case of a Bleeding Duodenal Lipoma Successfully Controlled by Endoscopic Resection

• Gwak SY
• Lee MK
• Lee YK

• KMID: 2500893
• DOI: http://doi.org/10.5946/ce.2019.035

Abstract

This is a case report of successful endoscopic resection (ER) of a bleeding duodenal lipoma. An 85-year-old woman who was diagnosed with asymptomatic subepithelial tumor of the duodenum 3 years ago visited the emergency room with hematemesis and was admitted to our hospital. Emergent esophagogastroduodenoscopy revealed bleeding from an ulcer on the superior aspect of a subepithelial tumor measuring about 20 mm in diameter, at the superior duodenal angle. The ulcer was in the active stage (A1), with a visible vessel. The bleeding was controlled by ER of the tumor using a snare. The final pathological diagnosis was duodenal lipoma with mucosal ulceration. The patient showed no signs of bleeding for 10 days after the procedure; subsequently, she was discharged and followed up for regular checkups.

Keyword

Lipoma of duodenum; Bleeding; Endoscopic resection

Figure

• 

  Fig. 1. Esophagogastroduodenoscopy and colonoscopy showing no peptic ulcers or evidence of gastrointestinal bleeding except for a duodenal subepithelial tumor (A, B) computed tomography scan showing a hypoattenuating lesion about 1.7 cm in diameter in the duodenum, suspected to be a lipoma (C) a 99mTechnetium-labeled red blood cell scintigraphy showing no abnormal uptake for 24 hours (D). ANT, anterior.

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  Fig. 2. Emergent esophagogastroduodenoscopy showing a subepithelial tumor (SET) at the duodenal bulb with a small blood clot (A) an oozing pattern of active bleeding observed after rotating the SET (B) bleeding arrested after injection of epinephrine into the lesion (C, D).

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  Fig. 3. A second esophagogastroduodenoscopy is performed after a later bleeding event. Blood clots observed on the surface of the ulcer on subepithelial tumor (A) polypectomy using a snare and the mucosal defect closed using hemoclips (B, C) the resected specimen is about 20 mm in diameter (D).

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  Fig. 4. A submucosal lipoma with mucosal ulceration (#), hemorrhage (black arrow), and granulation tissue (*) (hematoxylin and eosin [H&E], ×10); high-power view showing mature adipose tissue (H&E, ×200).

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