Obscure gastrointestinal bleeding caused by intestinal lipomatosis: double-balloon endoscopic and laparoscopic views.

by intestinal lipomatosis: double-balloon endoscopic and laparoscopic views A 52-year-oldwhitemanwithout co-morbidities presented with a 6-year history of recurrent abdominal pain and episodes of melena twice a week for the past year. He was started on oral iron sulfate supplements and had already received a blood transfusion. Findings from physical examination were normal. The hemoglobin level was 10.8g/dL. Gastroduodenoscopy and colonoscopy revealed several smooth sessile and pedunculated lesions covered by normal mucosa, which are characteristics of lipomas, and with no signs of bleeding. Double-balloon endoscopy (DBE) revealed innumerable similar subepithelial lesions, measuring 1–4cm in diameter, throughout the entire small bowel (●" Video 1). In the distal jejunum, multiple pedunculated lesions were seen, with twisted pedicles, superficial erosion, and covered by fibrin, suggestive of vascular damage (●" Fig.1, ●" Fig.2). Abdominal computed tomography scan showed multiple hypodense lesions compatible with lipomas, and areas of intussusception with mild proximal smallbowel dilation (●" Fig.3). The patient underwent laparoscopy, which confirmed irreducible intussusception, and led to minilaparotomy with four enterotomies and resection of multiple lipomas (●" Fig.4, ●" Fig.5). A total of 26 lesions were resected, including some with signs of bleeding. Histopathology confirmed the diagnosis of lipomatosis (●" Fig.6). The patient was discharged 3 days after surgery, and at the 5-month follow-up visit he remained asymptomatic with a hemoglobin level of 12.9g/dL. Lipomas of the gastrointestinal (GI) tract arebenign tumors and are usually solitary; however, they can rarely present as GI lipomatosis [1]. Althoughmostlyasymptomatic, GI lipomas may cause symptoms, including obstruction as a result of intussusceptions, and GI bleeding [2,3]. Treatment consists of surgical or endoscopic resection. Endoscopic options includemucosal or submucosal resection, unroofing technique, and application of an endoloop or endoclip [4,5]. This case demonstrated the endoscopic and laparoscopic characteristics of diffuse GI lipomatosis. DBE was essential to the diagnosis, and surgical resection resolved the intussusception and obscure GI bleeding.