P2082 - Significant Gastrointestinal Bleeding on Therapeutic Anticoagulation Due to Small Bowel Lipoma

Erin Currey, MD¹, Emily Buerschen, DO¹, Fadi Odish, MD², Mustafa Musleh, MD^1
1Wright State University Boonshoft School of Medicine, Fairborn, OH; ²Wright State University Boonshoft School of Medicine, Dayton, OH

Introduction: Gastrointestinal bleeding (GIB) is the most common extracranial cause of major bleed in patients requiring therapeutic anticoagulation, affecting 5-15% of patients. Yet, assessing patient risk for bleed can be clinically challenging; as anticoagulation is indicated in a variety of pathologies with diverse clotting and bleeding risks. GIB in the setting of therapeutic anticoagulation is commonly related to peptic ulcers, diverticula, angiodysplasia and colorectal neoplasia. Rarely, gastric lipomas are identified as the etiology.

Case Description/Methods: We present a case of a benign, submucosal small bowel lipoma as a cause of severe GIB. The patient was an 83-year-old male admitted to a tertiary facility for the management of new-onset atrial fibrillation with rapid ventricular rate and associated heart failure exacerbation. Pertinent past medical history included congestive heart failure and type 2 diabetes. He was initiated on therapeutic anticoagulation with continuous heparin infusion. Three days after the initiation of heparin, the patient began having dark, maroon-colored stool concerning for GIB. Bleeding became overtly concerning when he developed acute anemia with a hemoglobin drop from 16.5g/dL to 8g/dL within 48 hours. CT imaging was benign. However, a bleeding scan then revealed a bleed in the proximal small bowel and he required urgent enteroscopy. The enteroscope was advanced into the mid-jejunum, where melena without active bleeding was visualized. The scope was slowly withdrawn to the distal duodenum, where an unusual 4-cm pedunculated lesion with an ulcerated cap was discovered. Hot snare polypectomy was performed successfully without residual bleeding and hemoclips were placed to close the defect. Interestingly, surgical pathology revealed this mass was a benign, submucosal lipoma. The patient’s hemoglobin stabilized in the following days, and he ultimately elected for Watchman Device placement and has not had recurrence of GIB to date.

Discussion: Lipomas are common benign lesions found within the gastrointestinal tract. However, they rarely can cause symptoms or bleeding. This uncommon location for a lipoma re-emphasizes the importance of thorough endoscopic evaluation. Our case demonstrates an unusual case of small bowel bleeding due to a lipoma as well as our successful management strategy.



Disclosures:


Erin Currey, MD¹, Emily Buerschen, DO¹, Fadi Odish, MD², Mustafa Musleh, MD¹. P2082 - Significant Gastrointestinal Bleeding on Therapeutic Anticoagulation Due to Small Bowel Lipoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.