A 38-year-old Chinese man presented to our hospital with a 2-week history of dizziness
and of passing black stools. Laboratory test results included the following (with
normal ranges in parentheses): hemoglobin 4.9 g/dL (12 - 16 g/dL), red blood cell
count 1.76 × 1012/L (4.0 - 5.5 × 1012/L), white cell count 8.01 × 109/L (4.0 - 10.0 × 109/L), platelet count 333 × 109/L (100 - 300 × 109/L). Biochemical parameters, including electrolytes and liver and renal function tests
were within normal limits. Stool examination was positive for occult blood, but upper
gastrointestinal endoscopy and colonoscopy examinations were both negative. The patient
was transfused with 3 units of packed red blood cells. Capsule endoscopy (OMOM; Chongqing
Jinshan Science & Technology Inc., China) was performed in order to further evaluate
the patient’s occult gastrointestinal tract bleeding and this showed a polypoid lesion
with a surface ulcer in the small bowel ([Fig. 1]). Double-balloon enteroscopy confirmed this finding in the jejunum, 70 cm distal
(anal) to the ligament of Treitz ([Fig. 2]).
Fig. 1 Capsule endoscopy revealed a polypoid lesion in the small bowel, with surface ulceration.
Fig. 2 Double-balloon enteroscopy showed a polypoid lesion with a surface ulcer in the jejunum,
70 cm distal (anal) to the ligament of Treitz.
The patient underwent a jejunal resection and the surgical specimen showed a polypoid
lesion measuring 0.8 cm × 0.8 cm. Histologic examination revealed surface mucosal
necrosis and the presence of enlarged, twisted, thick-walled blood vessels with local
rupture and thrombosis in the submucosa, surrounded by an inflammatory infiltrate
([Fig. 3]). The diagnosis of vascular malformation was suggested. There has been no recurrence
of gastrointestinal bleeding 4 months after the jejunal resection.
Fig. 3 Histologic examination revealed surface mucosal necrosis and enlarged, twisted, thick-walled
blood vessels in the submucosa (hematoxylin and eosin stain, original magnification
× 40).
This type of vascular lesion can cause occult gastrointestinal bleeding. Capsule endoscopy
and double-balloon enteroscopy are useful in the diagnosis of such lesions, and surgical
resection is regarded as a curative treatment. Perhaps, in the future, this type of
vascular lesion will be removed by interventional double-balloon enteroscopy.
Endoscopy_UCTN_Code_CCL_1AC_2AB
Endoscopy_UCTN_Code_CCL_1AC_2AC
