S4753 Gastric Lipoma: A Rare Cause of Gastrointestinal Bleed

Introduction: Gastrointestinal lipomas are unusual, slow growing benign tumors, with gastric lipomas being rarer accounting for only 1% of all gastric tumors and 5% of gastro-intestinal lipomas. 95% of the gastric lipomas are submucosal with sub-serosal lipomas being extremely rare. Usually asymptomatic. Rarely they can cause symptoms like gastric outlet obstruction, GI bleeding, intussusception owing to size and ulceration. Case Description/Methods: A 54-year-old-woman with no co-morbid conditions, presented to the emergency department with complaints of sweating, dizziness, associated with melena and hematemesis. Past medical/ surgical/ drug history was insignificant. Physical examination was unremarkable except for pallor. Her hemoglobin was 6.8 gm/dl (baseline 11 g/dl), platelet count 2 lakhs/cu mm, leucocyte count 10,000 cells/cu mm. Rest of the comprehensive metabolic panel was normal. Electrocardiogram, chest x-Ray, echocardiogram, ultrasound abdomen was normal. Troponin-I was negative. After initial stabilization in the emergency department, she was taken up for Upper gastro-intestinal endoscopy which showed a 5-6 cm smooth, rounded lesion in the body of the stomach with surface ulcer, with no active ooze, showing positive pillow-sign and tenting-sign. Computerized tomography scan of the abdomen was done which showed a large, well-defined sub-mucosal mass measuring approximately 55 × 40 mm, arising from mid-body of the stomach with faint internal inhomogeneity and attenuation between -70 and -80 Hounsfield units (HU) - suggesting gastric lipoma. The patient underwent diagnostic laparoscopy and excision of the sub-mucosal lipoma. Histopathology from the resected specimen showed mature adipocytes, separated by fibrous septa with focal lymphocyte aggregates confirming lipoma. At follow-up, the hemoglobin was stable at 10.8 gm/dl and the patient did not report any further episodes of GI bleed. Discussion: Although rare, gastric lipomas can cause significant life-threatening GI bleed which would warrant intervention. The best diagnostic modalities for gastric lipoma are Endoscopy, Computerized tomography and Endoscopic ultrasound (EUS). The choice of treatment for gastric lipoma remains controversial. A detailed pre-operative evaluation is needed as coincidental separate malignant lesions have been reported by Yamamoto et al. in 2004. In our case, as she was symptomatic with GI bleed, she had diagnostic laparoscopy and excision of the sub-mucosal gastric lipoma with positive outcome at follow-up.