Hemangioma of the intestine

Abstract

F. J. D., Denver ChiIdren’s HospitaI No. ~-8703, a girl aged sixteen years, was admitted March 7, 1942, because of a marked anemia. The provisiona diagnosis was anemia, etioIogy unknown. Her family history was negative with no known bIeeding tendency. In her past history, chiIdren’s diseases were noted, she was subject to winter coIds, the tonsiIs and adenoids had been removed at seven years without incident and she had had bronchopneumonia two years before. She had aIways been pale as Iong as she can remember. More severe paIIor came in attacks usuaIIy foIlowing some infection or gastrointestina1 upset. These attacks were associated with nausea and vomiting, cramps, pain in the back and marked weakness. They occurred severa times yearIy. She was toId that after these attacks her hemogIobin became as low as 40 per cent. After each attack she took liver and iron medicine and graduaIIy improved. There was never noted any blood by bowel but at times the stools were quite black which appearance was ascribed to the iron. She has had a food craving, often eating paper, usually the unprinted part of magazines. Menstruation started a year before entrance and had been reguIar and scant. PhysicaI examination was essentiaIIy negative except for her skin which was paIe and wax-like. The mucous membranes were aIso quite paIe. Over the heart was heard a systolic murmur most pronounced at the base. The abdomen was negative except that the spIeen couId be feIt on deep inspiration. On admission the hemogIobin was 22 per cent, red bIood count I, 120,000, white bIood count 6,400 with 79 per cent poIymorphonucIears and 18 per cent Iymphocytes; there were no abnorma1 ceIIs. ReticuIocytes made up I .6 per cent of the reds. The stooIs were strongIy positive for bIood by the guaiac and benzidene test on a meat-free diet. The tota protein was sIightIy Iow, 4.8. AI1 other Iaboratory tests incIuding an icteric index, red ceil fragiIity, sterna1 puncture, gastric anaIysis and bIood Wassermann were negative. A gastrointestina1 x-ray series was normal, the jejunum and iIeum being checked three times. Sigmoidoscopic examination was negative. The chiId received frequent transfusions, a tota of six preoperativeIy but the highest bIood IeveI was onIy 44 per cent with 2,880,ooo red bIood corpuscles. This was on March 31, 1942. However, on ApriI 8, 1942, the chiId had rather severe abdomina1 pain, food craving appeared-she desired oIives and paper-and the stooIs appeared quite dark but not tarry. FolIowing transfusion a Iaparotomy was done on ApriI II, 1942. A right rectus retracting incision reveaIed immediateIy a purpIish tumor covering roughIy 4 inches of the iIeum over its whoIe circumference about 14 inches above the cecum. There were no adhesions. The bIood suppIy did not seem to be excessive. The appearance was that of a mass of deep purpIe varicose veins. No other abnormaIity in the intestine was noted. There was a Iong norma appearing appendix and no MeckeI’s diverticulum. Six inches of the smaI1 intestine were resected, the ends cIosed and a IateraI anastomosis performed with an inner Iayer of continuous fine catgut and an outer of interrupted silk. (Figs. I and 2.) The postoperative course was entireIy uneventful. The bIood remained up without transfusion, the stooIs were negative for blood and the bIood count at the time of discharge on