Massive Duodenal Angiolipoma: A Rare Case with Severe Haemorrhage.

Abstract

Introduction: Duodenal angiolipoma is an exceptionally rare and often misdiagnosed clinical entity, characterized by a benign proliferation of adipose and vascular tissues. When large, these lesions pose a significant diagnostic challenge, frequently mimicking malignancy during endoscopic evaluation, especially in cases of severe gastrointestinal haemorrhage. Rapid recognition and decisive management are critical, requiring hemodynamic stabilization, advanced diagnostic tools, and expert intervention to prevent life-threatening complications.

Case description: We present the case of a 71-year-old female who arrived at the emergency department with acute upper gastrointestinal haemorrhage and hemodynamic instability. Immediate resuscitation, including haemostatic pharmacotherapy and blood transfusion, was initiated. Subsequent endoscopic evaluation, enhanced by endoscopic ultrasound, revealed a 2 × 3 cm duodenal lesion with a high-risk vascular structure. To prevent further haemorrhage, the tumour was swiftly ligated with an endoloop and excised via polypectomy. Histopathological analysis confirmed duodenal angiolipoma, characterized by mature adipose tissue interwoven with proliferative vascular elements. Following intervention, the patient recovered rapidly, with no recurrence of haemorrhage, and was discharged in stable condition.

Conclusion: Massive duodenal angiolipomas causing severe haemorrhage to require appropriate medical haemostasis and resuscitation. Timely recognition and diagnosis via endoscopic ultrasound are vital. Endoscopic resection is a safe and effective treatment that prevents recurring bleeding in this case.

Learning points: Duodenal angiolipomas are rare benign tumours that can mimic malignancies and cause life-threatening gastrointestinal bleeding.Endoscopic ultrasound and computed tomography scan are essential for differentiating these tumours from malignant lesions and guiding treatment.Endoscopic resection is a safe, minimally invasive option for duodenal angiolipoma to prevent recurrent bleeding, especially in resource-limited settings.