A finger in the duodenum

A 70-year-old man developed melaena after taking aspirin and clopidogrel for 2 months to treat ischaemic heart disease. Other medications the patient was taking included metformin and metoprolol. A lipoma, the endoscopic appearance of which resembled a finger (Figure), was the only endoscopic abnormality. It was resected endoscopically, with the aid of an endoloop to cut off its blood supply before removal with a snare. The diagnosis was histologically confirmed but ulceration was not found, possibly because one section of the lesion was not retrieved. Lipomas are soft and typically appear as an isolated bulge of smooth mucosa, often with a yellow hue. Such lesions bleed rarely.