2002 Oh My Lipoma: An Unexpected Cause of a Gastrointestinal Hemorrhage

Abstract

INTRODUCTION: Gastrointestinal (GI) lipomas are benign tumors made of adipose tissue that are usually asymptomatic and slow-growing. Lipomas of the GI tract are uncommon, and even less common to find in the gastric region. Around 220 cases of gastric lipomas are reported in the literature. Of these cases, very few have shown a gastric lipoma that leads to symptomatic anemia and hemorrhage. CASE DESCRIPTION/METHODS: A 48-year-old man with a history of hypertension presented to the emergency room with shortness of breath and was found to have a hemoglobin of 6.0 g/dl, with a baseline of 15 g/dl. Gastroenterology was consulted, and the patient had an esophagogastroduodenoscopy (EGD) performed. The EGD showed a large, 4 cm, polypoid, submucosal, ulcerated mass with active oozing of blood on the lesser curvature of the gastric body. Biopsies were taken, and computed tomography (CT) imaging was performed as there was concern this was a malignant mass. Pathology showed the mass to be a gastric lipoma, and the patient was taken for a partial gastrectomy to remove the lipoma due to risk for bleeding. The surgery was performed without complications. DISCUSSION: Interestingly, gastric lipomas account for less than 1% of tumors in the stomach. This case displays a rare finding of a large gastric lipoma that led to symptomatic anemia and gastrointestinal hemorrhage. Most gastric lipomas are asymptomatic, but can ulcerate depending on the size and location. Ulceration can occur as a result of pressure necrosis of overlying mucosa, causing large volume bleeding. Lipomas can be diagnosed with endoscopic ultrasound, EGD, and CT scan. Treatment modalities include aspiration lumpectomy, strip biopsy, endoscopic unroofing technique, or surgical removal with partial gastrectomy. Rarely are gastric lipomas removed surgically, but in the case of large volume blood loss or active bleeding, they are removed surgically rather than endoscopically. Of note, it is important to rule out any evidence of malignancy or metastatic disease with imaging prior to surgical removal of a lipoma. If malignancy is ruled out, oftentimes endoscopic removal of the lipoma can be performed rather than undergoing a large surgical resection.