A unique case of massive gastrointestinal bleeding

Abstract

Objectives: Lipomas are the second most common benign tumors of the small bowel, and most lipomas are asymptomatic. However, lipomas with diameters of >20 mm tend to be symptomatic, for example, to cause bleeding, obstructive jaundice, abdominal pain, intestinal obstruction, intussusception, and/or perforation.

Methods/results: We report a case of massive gastrointestinal bleeding from a jejunal lipoma combined with intussusception. A preoperative diagnosis of gastrointestinal bleeding derived from a jejunal lipoma combined with intussusception was made based on double-balloon enteroscopy and contrast-enhanced computed tomography, and partial resection of the small intestine was performed. After surgery, there was no additional gastrointestinal bleeding.

Conclusion: There have only been a few reports about cases of jejunal lipoma involving simultaneous bleeding and intussusception. Double-balloon enteroscopy is useful for preoperatively diagnosing bleeding from a lipoma. Our case highlights that jejunal lipoma can cause massive unexplained gastrointestinal bleeding.

Keywords: Gastrointestinal bleeding; intussusception; jejunal lipoma.

Figure 1.

(a) A 40-mm yellow pedunculated tumor was detected in the jejunum. (b) The tumor’s surface was villous, exhibited edema-like swelling, and contained an oval ulcer. (c) The red arrow shows a fat-containing mass. The white arrow indicates the intussusception at the top of the tumor.

Figure 2.

(a) The tumor measured 40 mm in diameter. The red arrow shows that the mucosa overlying the tumor had ulcerated. (b) A pathological examination showed mature fat cells and resulted in a diagnosis of lipoma.