Ewha Med J.  2024 Jan;47(1):e8. 10.12771/emj.2024.e8.

Endoscopically resected duodenal lipoma as an uncommon cause of upper gastrointestinal bleeding: a case report

• Joo DC
• Kim GH
• Lee BE
• Lee MW
• Kim C

• KMID: 2553300
• DOI: http://doi.org/10.12771/emj.2024.e8

Abstract

Subepithelial tumors in the upper gastrointestinal (GI) tract are often detected during nationwide endoscopic gastric cancer screening in Korea. Most GI lipomas are asymptomatic and do not necessitate further treatment. However, large tumors may lead to complications such as bowel obstruction, intussusception, and bleeding. These GI lipomas require endoscopic or surgical resection. On radiological examination, GI lipomas typically manifest as hypodense lesions with similar density to that of fat tissue. White-light endoscopy generally reveals a yellowish subepithelial tumor exhibiting a positive cushion sign, while endoscopic ultrasonography shows a homogeneous hypoechoic mass within the third layer of the GI tract. We present the case of an 81-year-old woman with symptomatic duodenal lipoma following endoscopic resection.

Keyword

Duodenum; Lipoma; Gastrointestinal hemorrhage; Endoscopic mucosal resection

Figure

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  Fig. 1. Abdominal CT revealed a hypodense mass in the third portion of the duodenum (indicated by the white arrow).

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  Fig. 2. Endoscopic findings of duodenal lipoma. (A) A 3-cm duodenal lipoma, presenting as a polypoid mass. (B) Multiple ulcerations were observed on the tip of the lesion. (C) A bleeding focus was identified on an ulcer located on the lipoma. (D) Endoscopic ultrasonography revealed a homogeneous hyperechoic mass (indicated by the white arrow). The muscle layer remained intact. The lesion appeared stretched, causing the fold to overlap; consequently, multiple mucosal and submucosal layers were visible beneath the duodenal lipoma (indicated by the black arrow).

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  Fig. 3. Endoscopic resection of the duodenal lipoma. (A,B) Submucosal injection and an endoloop were applied to prevent bleeding and perforation. (C) Following polypectomy, the mucosal defect was sealed with endoclips. (D) The resected specimen measured approximately 3.0 cm, and “naked” fat was noted at the resection margin.

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  Fig. 4. Microscopic finding showing submucosal lipoma with ulceration. (A) Hematoxylin and eosin (H&E) stain, ×5 magnification. (B) High-power view reveals mature adipocytes, indicating lipoma (H&E stain, ×200 magnification).

Reference

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