An unusual cause of gastrointestinal bleeding: duodenal lipoma

Abstract

Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.

Keywords: CT scan; Endoscopy; Submucosal excision; Surgery.

Fig. 1

Endoscopic appearance of the polyp arising from D1, demonstrating the ulcerated surface and a broad base.

Fig. 2

CT showing large D1 polyp intussuscepting into D2 (arrowhead), but no obvious CT scan characteristics of a lipoma.

Fig. 3

Macroscopic appearance of the resected specimen, demonstrating a broad base of nearly 4 cm (confirming the need of surgery rather than endoscopic excision for complete removal) with wasting around the site of intussusception. The mucosa demonstrates signs of chronic injury in terms of ulceration and hyperproliferative surface. The transected surface shows typical features of a submucosal lipoma.