Gastric Lipoma Presenting with Massive Upper Gastrointestinal Bleeding

A case of massive upper gastrointestinal bleeding in a 37-year-old female is presented showing a submucosal mass in the gastric body. At laparotomy a pedunculated submucosal mass was found located on the posterior wall at the junction of the body and antrum of the stomach, 8？cm from the pylorus. Pathology confirmed that it was a 4？cm benign gastric lipoma with a bleeding central ulcer. Gastric lipomas are rare, benign, typically submucosal tumors occurring in the gastric antrum. They are usually asymptomatic but can become symptomatic depending on size, location, and if there is ulceration of the lesion. These lesions may be mistaken as malignant tumors or present with upper GI bleeding or intussusception. The diagnosis can be made using a combination of upper endoscopy, endoscopic ultrasound, CT, and MRI with surgical excision being the definitive treatment of choice. We hope that this case highlights the fact that these lesions can present with massive upper GI haemorrhage and should be included in the diagnosis when appropriate. 1. Introduction Gastric lipomas are rare and account for less than 1% of all tumors of the stomach and 5% of all gastrointestinal lipomas [1, 2]. They typically occur in the 5th or 6th decade of life with equal sex incidences and 75% occur in the antral region in the submucosa or serosal layers [3]. They are usually asymptomatic and are commonly detected incidentally; however, they may present with gastric outlet obstruction and upper gastrointestinal bleeding. Approximately 220 cases have been reported in the medical literature and further only two cases have been reported presenting with massive upper gastrointestinal haemorrhage [4, 5]. 2. Case Report A 37-year-old female presented with a four-day history of epigastric pain and melaena associated with vomiting. The pain was sudden in onset, severe, and with no radiation. There were no aggravating factors and it was associated with three episodes of black, tarry, and foul-smelling stool. She had a history of weakness, dyspnoea, headaches, and palpitations (symptoms of anaemia) and used Ibuprofen for menstrual cramps on a monthly basis. There was no history of cigarette smoking, alcohol use, peptic ulcer disease, or reflux. Examination revealed pale mucous membranes and epigastric tenderness. The haemoglobin dropped to 5.9？g/dL and she was transfused 6 units of packed cells. An upper GI endoscopy revealed a normal oesophagus, cardia, and fundus with a submucosal mass with a 1？cm ulcerating area in the gastric body. The patient was prepared for a laparotomy and an anterior