Supplemental Material for: Ulcerated Lipoma as a Hidden Culprit in Iron-Deficiency Anemia: A Case Report

Small bowel capsule endoscopy (SBCE) was therefore performed to investigate potential sources of small bowel bleeding. It demonstrated multiple yellowish subepithelial lesions throughout the small bowel and a jejunal large lesion with luminal bulging, edematous mucosa, and superficial ulceration (shown in Fig. 1A, B). Because the ulcerated proximal lesion was considered a probable source of chronic occult blood loss, antegrade single-balloon enteroscopy was performed.

At 60 cm beyond the pylorus, a 40 mm semipedunculated, congestive, superficially ulcerated lesion was identified (shown in Fig. 1C, D). Although ulceration in a large small-bowel subepithelial lesion may raise concern for other neoplasms, including gastrointestinal stromal tumor, neuroendocrine tumor, or small-bowel adenocarcinoma, the multifocal fat-density lesions on computed tomography and the typical yellowish, soft-appearing endoscopic morphology strongly favored gastrointestinal lipomatosis.

Given the semipedunculated morphology, endoscopic accessibility, and suspected role as the bleeding source, endoscopic resection was preferred over surgery, as it offered a minimally invasive approach with potential for definitive treatment and histological confirmation. After submucosal injection with gelatin solution, methylene blue, and diluted epinephrine, it was removed with a diathermic snare; the mucosal defect was closed with five through-the-scope clips (shown in Fig. 1E, F).

Histology confirmed a submucosal lipoma with focal erosion/ulceration. Oral iron supplementation was prescribed after endoscopic treatment, according to standard care. At 6 months, no overt bleeding or recurrent anemia was observed, and hemoglobin had normalized to 15.6 g/dL.</p>