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Giant lipomas of the stomach are very rare, accounting for less than 3% of all benign tumors of the stomach. A clear-cut endoscopic differentiation between gastric lipomas and other submucosal neoplasms is not feasible, because routine endoscopic gastric biopsies do not reach the submucosal layer. Gastric submucosal lipomas can cause gastric ulceration as in the case presented below and in rare instances this may in turn promote gastric cancer. Therefore, complete pretreatment diagnostic evaluation is needed. We present a 52-year-old man with a 6-month history of epigastric discomfort, early satiety, decreased appetite, and dyspepsia. His weight was noted to be stable and he was iron deficient (hemoglobin 11.5 g/dl and ferritin of 5 g/dl). His past history included a gastric ulcer found on endoscopy 5 years ago for which he was on omeprazole 40 mg once a day, hypertension, hypercholesterolemia, and diabetes. Clinical examination revealed central obesity with divarification of recti muscles. He underwent a colonoscopy that was normal, and an oesophago-gastro-duodenoscopy that revealed a smooth extrinsic indentation of the anterior aspect of the distal stomach at around 50 cm. Biopsies of this were normal. A computed tomography scan was obtained () that demonstrated a 14 by 15-cm fatty tumor arising from the distal stomach with a couple of 5-mm nodes adjacent to tumor and no distant metastasis representing either a lipoma, liposarcoma or gastrointestinal stromal tumours. He subsequently underwent a subtotal gastrectomy. Macroscopically, the antrum was distorted by a huge submucosal intramural tumor mass. The antral mucosa was stretched over its surface and bore a central 15-mm ulcer surrounded by a raised border (). Microscopic examination confirmed an ulcerated benign submucosal lipoma. Our patient was symptomatic with a large gastric lipoma that necessitated surgical excision. Following surgery his postoperative recovery was uneventful, and he was asymptomatic when reviewed 4 weeks later. This case demonstrates a rare case of gastric lipoma causing gastric epithelial ulceration leading to iron deficiency.

Introduction With the advent of the Bowel cancer screening programme (BCSP) in the UK participants who have positive FOB tests are generally offered optical colonoscopy (OC) if considered safe, for early detection and prevention of CRC. In our study we undertook Computed Tomographic Colonography (CTC) in our hospital as the investigation of choice in those FOBt positive individuals with an American Society of Anesthesiology (ASA)grade > = 3 and analysed outcomes. Methods Cases were prospectively discussed with screening practitioners carrying out assessments prior to OC and on the basis of hospital records and liaison with primary care physicians were assigned to CTC/OC with majority proceeding to OC as per standard practise. Patient data was accessed from our database in radiology, endoscopy and histology retrospectively and ASA grade assigned on the basis of the above information.44/69 cases that were referred for CTC from the BCSP between Feb 2009 and Nov 2011, were considered to have an ASA > = 3.CTC results were analysed and correlated with endoscopic and histological findings. Results Out of 44 cases (17 female,27 male, mean age 65.4) with positive FOBt referred for CTC in the BCSP,50%(22) of patients had positive findings i.e.18 polyps and 4 suspected CRC.3/44 cases had a normal Flexible Sigmoidoscopy (FS) before CTC. Hence 41 of the above were considered to have had a primary CTC.44% (18/41) of patients referred for primary CTC had an endoscopy (20% OC,24% FS), of which 61% had a polypectomy.41 primary CTCs detected 32 polyps in 18 cases and 4 cancers.18 cases (4 diminutive polyps on CTC not requiring OC/FS) underwent endoscopy as a result of the above (OC 8, FS 10) detecting 36 polyps (35 removed) in 11 patients.86% of polyps were detected on the left side and the majority of this (83%) were histologically confirmed to be adenomas. In addition to this 2 left sided cancers was confirmed endoscopically. Conclusion In this small cohort CTC seems comparable to colonoscopy for detection of polyps and cancers1.In the patient group selected almost 44% of cases thought to have significant comorbidity who had primary CTC ended up having a lower GI endoscopy along with a need for therapy. It is also noted that the majority of significant polyps and all cancers were located in the left colon. We suggest that in this group a larger study evaluating a combination of CTC with FS (with no or minimal sedation) would be most appropriate in the context of the BCSP. It may also be useful to have evidence based criteria on fitness for colonoscopy in order to inform individuals and programmes on the appropriateness of screening in the context of comorbidity and the risk to benefit ratio. Disclosure of Interest None Declared. Reference Laghi, A et al . Current status on performance of CTC and clinical indications. EJR.doi:10.1016/j.ejrad.2012.05.026