Small bowel bleeding accounts for 5–10% of all gastrointestinal bleeding cases, with
small bowel hemangioma being one of the most common causes. It is characterized by
an insidious onset and a high recurrence rate [1]. The standard treatment for small bowel hemangioma is surgical resection, which
is both invasive and costly [2]. Recently, endoscopic injection sclerotherapy, typically used for esophageal varices,
has been increasingly applied to treat gastrointestinal vascular lesions, including
small bowel hemangioma [3].
We report the case of a 52-year-old woman with no underlying systemic disease, who
presented to our hospital with a 6-month history of recurrent melena and anemia. Laboratory
tests revealed iron deficiency anemia, with a hemoglobin level at 6.9 g/dL. Contrast-enhanced
abdominal computed tomography, esophagogastroduodenoscopy, and colonoscopy did not
identify a bleeding source. Subsequently, peroral double-balloon enteroscopy revealed
a 2.0-cm irregular, elevated lesion in the middle of the jejunum. The lesion was soft
and non-pulsatile, consistent with the appearance of a hemangioma ([Fig. 1]
a, [Video 1]). Bleeding points were identified in the central depression of the lesion, indicating
the bleeding source ([Fig. 1]
b). Methylene blue dye was applied to delineate the margins of the lesion ([Fig. 1]
c). After confirming positive blood reflux, we performed endoscopic injection sclerotherapy
using an 8-ml polidocanol-methylene blue mixture ([Fig. 1]
d). After the injection, the hemangioma was notably reduced in size ([Fig. 1]
e). For future radiological or surgical reference, a metal clip was anchored to the
proximal part of the jejunum, 5 cm away from the lesion ([Fig. 1]
f). The patient remained free of recurrence during the 1-year follow-up.
Endoscopic injection sclerotherapy for a hemangioma located in the middle part of
the jejunum using peroral double-balloon enteroscopy in a 52-year-old woman with recurrent
melena and anemia.Video 1
Fig. 1 Peroral double-balloon enteroscopy-guided endoscopic injection sclerotherapy for a
hemangioma located in the middle part of the jejunum. a Double-balloon enteroscopy showing an irregular elevated lesion in the middle part
of the jejunum. b Bleeding spots located in the central depressed part of the lesion, indicating the
bleeding source. c Methylene blue was applied to the lesion to delineate its margins. d Positive blood reflux was seen within the puncture needle. e After the injection, the hemangioma was reduced in size. f For future radiological or surgical reference, a metal clip was anchored to the jejunal
wall in the proximal part of the jejunum, 5 cm away from the lesion.
Endoscopic intervention for small bowel hemangioma poses significant challenges due
to anatomical and technical limitations. Although various endoscopic treatments, such
as double-balloon enteroscopy-guided argon plasma coagulation, polypectomy, and endoscopic
mucosal resection, have been proposed for small bowel hemangioma, a definitive consensus
on the optimal approach is lacking [2]
[4]. Based on our experience, double-balloon enteroscopy-guided endoscopic injection
sclerotherapy is a simple, effective, convenient, and minimally invasive procedure
that requires only a standard injection needle. It should be considered a preferred
treatment option for small bowel hemangioma, particularly in patients with recurrent
episodes or those who are unsuitable for surgery.
Endoscopy_UCTN_Code_TTT_1AP_2AD
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