An 83-year-old man, with a history of hypertension, diabetes, and chronic liver disease,
presented to the emergency room with fatigue and melena. Blood tests revealed iron-deficiency
anemia (Hb 6.5 g/dL). Esophagogastroduodenoscopy (EGD) showed a Forrest III ulcer
in the gastric antrum and a small, nonbleeding gastric angiodysplasia, which was treated
with argon plasma coagulation. As colonoscopy was unremarkable, the patient was discharged
after a few days.
The patient was readmitted 3 months later for recurrence of bleeding. Repeat EGD was
negative for bleeding lesions; therefore, capsule endoscopy was performed in <48 hours.
Capsule endoscopy showed a 5-mm ulcerated polyp with an adherent clot in the jejunum
(Saurin P2 lesion) ([Fig. 1]). A push enteroscopy (SIF-H190; Olympus, Tokyo, Japan) was then performed, confirming
the finding of a sessile polyp in the mid jejunum ([Fig. 2]), which was removed en bloc with a braided snare after submucosal injection. Finally,
the base was prophylactically closed with hemoclips ([Fig. 3], [Video 1]).
Fig. 1 Capsule endoscopy detected a jejunal P2 lesion (Saurin classification).
Fig. 2 Enteroscopic image of the ulcerated 5-mm polyp in the mid jejunum.
Fig. 3 The cutting base was closed with hemoclips after mucosal resection.
Capsule endoscopy diagnosis and enteroscopic resection of a jejunal cavernous hemangioma
in a patient with recurrent bleeding episodes.Video 1
Histology of the specimen showed jejunal nondysplastic ulcerated mucosa, with vascular
proliferation and dilation of the capillaries ([Fig. 4]). The results were consistent with the diagnosis of cavernous hemangioma.
Fig. 4 Histological diagnosis of cavernous hemangioma.
Cavernous hemangiomas are rare vascular malformations of mesenchymal origin, potentially
involving the small bowel and accounting for 7%–10% of all benign tumors in this gastrointestinal
segment [1]
[2]
[3]. Similarly to other benign small-bowel tumors, cavernous hemangioma may remain asymptomatic
for many years before becoming clinically manifest, usually with iron-deficiency anemia
or with gastrointestinal bleeding (either overt or occult, often intermittent) [4]
[5]. Although small-bowel cavernous hemangioma is mostly common in the young, elderly
patients may also be affected [1]
[3].
At a 3-month follow-up, the patient remained asymptomatic with no bleeding recurrence,
showing that enteroscopic resection is a safe therapeutic option for cavernous hemangioma.
Endoscopy_UCTN_Code_TTT_1AP_2AD
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