Intestinal Hemangioma Research Articles

015. A Gastrointestinal Infantile Hemangioma: A Rare Case Report and Literature Review

Background: Small intestinal hemangioma in children is a rare case. The most common predilection is jejunum area. History taking, physical examination, and supporting examinations are needed to help establish the diagnosis. Case: 1 year old girl came with complaints of vomiting with blood since the age of 6 months with frequency 10x/day everytime she eats and drinks. The patient has been given treatment according to the diagnosis of pulmonary tuberculosis and digestive problem, then referred to dr. Kariadi hospital because there was no improvement. Based on examinations, the patient was diagnosed with obstructive ileus at the level of jejunum and exploratory laparotomy was performed. Multiple hemangiomas of 14 x 5 cm were found in the jejunum and confirmed by anatomic pathological examination. Six days after the operation, the child was allowed to go home. Conclusion: Although this case is a rare case in children and include benign tumors, it is necessary to perform a quick diagnosis and appropriate management to prevent mortality and morbidity in children due to gastrointestinal bleeding.

From Severe Anemia to Intestinal Hemangiomatosis, a Bumpy Road—A Case Report and Literature Review

Gastrointestinal hemangiomas (GIH) are unusual vascular tumors found anywhere alongside the GI tract, the small bowel being the most common site. Diagnosis requires good clinical insight and modern imaging. This is a comprehensive review of the literature, starting from a new pediatric case diagnosed through exploratory laparotomy after complex imaging techniques failed. This research was conducted on published articles from the past 25 years. We identified seventeen original papers (two series of cases with three and two patients, respectively, and fifteen case reports). The female/male ratio was 1.5. The youngest patient was a 3-week-old boy, and the was oldest a 17-year-old girl. The most common localization was the jejunum (eight cases), followed by the ileum (four), colon (three), stomach (two), and rectum (one). Seven children had cavernous and four had capillary hemangiomas. Eight patients presented gastrointestinal bleeding, seven had refractory anemia, such as our index patient, three had recurrent abdominal pain, and two had bowel obstruction. Surgical assessment was successful in fifteen cases; three cases experienced great outcomes with oral propranolol, one child was treated successfully with sirolimus, and for one patient, endoscopic treatment was the best choice. The authors present the case of a female patient admitted to the Pediatrics Department of “Grigore Alexandrescu” Emergency Children’s Hospital from 25 February to 28 March 2019 for severe anemia, refractory to oral iron treatment, and recurrent blood infusions. No clear bleeding cause had been found. Although very uncommon, intestinal hemangiomas can express puzzling, life-threatening symptoms. We should keep in mind this disorder in cases of unresponsive chronic anemia.

Intestinal hemangiomas in 8 horses.

This retrospective study describes 8 cases of intestinal hemangioma diagnosed in horses during postmortem examination or surgical biopsy at the University of Tennessee College of Veterinary Medicine. In all cases, the intestine was the sole organ affected, and lesions were focal (3/8) or multifocal (5/8). Nodules were most commonly within the small intestine (7/8), particularly the jejunum (5/7). One case was in the left dorsal colon, which is the first report of hemangioma in the large colon of a horse. Lesions were discrete, raised, smooth, black to red, and ranged from 2 to 15 mm in diameter. Microscopically, all lesions were cavernous type and mural, most frequently within the muscularis (6/8). A majority of cases occurred in middle aged to older horses (average age of 19.3 years), and no breed or sex predilections were identified. The hemangiomas were considered incidental findings.

An adult case of small bowel intussusception caused by hemangioma presenting with intestinal obstruction: A case report

Both small bowel intussusception in adults and small bowel hemangioma are rare benign mass lesions. Moreover, a secondary effect of intussusception caused by hemangioma is extremely rare. A 87-year-old female suffered from intussusception and intestinal obstruction caused by hemangioma located in the small bowel (February 14, 2020), reporting abdominal distention without nausea and vomiting. Emergency abdominal and pelvic computed tomography showed an intussusception with the evidence of associated small bowel obstruction. Histological analysis revealed as small intestinal hemangioma accompanied by mesenteric ulcer. The patient underwent segmental resection of intussusception of intestine instead of invalid conservative treatment. Although the postoperative pathological results were inconsistent with preoperative imaging examination, the old woman recovered well. The literature on intussusception of small intestine has described several possible causes including hemangioma, which more likely results in gastrointestinal bleeding or abdominal pain. Yet we experienced a rare case presenting as abdominal distention without nausea and vomiting, Therefore, preoperative diagnosis and localization of these lesions is of great importance. We recommend high resolution contrast-enhanced computed tomography and magnetic resonance imaging should be considered in diagnosis while capsule endoscopy is not available owing to the intestinal obstruction, as long as in facilitating surgical excision.

Small intestinal hemangioma with chronic ulcer misdiagnosed as malignant tumor on the preoperative 18F-FDG PET/CT and PET/MR

We report the case of a 35-year-old male patient who complained of abdominal pain for 3 months. Both 18F-FDG PET/CT and abdomino-pelvic PET/MR revealed thickened intestinal wall in the pelvic group with elevated FDG uptake, which was misdiagnosed as malignant intestinal lesion. To our surprise, the lesion was histologically confirmed to be a small intestinal hemangioma with chronic ulcer and intussusception. Small intestinal hemangiomas are very rare benign tumors of the gastrointestinal tract and may lead to eventual misdiagnosis when the tumor and lymph nodes show a malignant sign of high FDG uptake, which should be noted by nuclear medicine physicians.

Cavernous hemangioma of the small intestine diagnosed by capsule endoscopy in an 8-year-old girl

Cavernous hemangiomas of the small intestine are rare. Usually, early diagnosis is difficult because patients are often asymptomatic for a long period. In recent years, capsule endoscopy has been used to diagnose small-bowel lesions with small-intestinal bleeding in pediatric patients. Herein, we present a case of cavernous hemangioma of the small intestine diagnosed by wireless capsule endoscopy in an 8-year-old girl. To our knowledge, this is the youngest case reported in Japan. Additionally, we reviewed pediatric case reports of small intestinal cavernous hemangiomas. The use of wireless capsule endoscopy in children is effective and safe for preoperative detection of gastrointestinal bleeding caused by small intestinal lesions. • The intestinal hemangioma is rare disease. • There are only 10 cases reported solitary cavernous hemangiomas of the small intestine during childhood. • The use of the wireless capsule endoscopy in children is effective for preoperative detection of intestinal bleeding.

Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception\u2014a case report and literature review

BackgroundCases with intussusception caused by either intestinal hemangiomas or appendiceal mucinous neoplasms are extremely rare.Case presentationIn this study, we reported a 47-year-old male presented with paroxysmal abdominal pain and postprandial bloating for 3 days. CT results indicated a high possibility of secondary intussusception in ascending colon. Histopathology indicated a mixed type of cavernous and capillary hemangioma, combined with low-grade appendiceal mucinous neoplasms (LAMNs) and intestinal obstruction. The patient underwent laparotomy and right hemicolectomy. Finally, the patient was followed up for 4 months with no disease progression.ConclusionsRare studies reported the intestine hemangiomas coincided with appendix low-grade mucinous tumor. Its manifestations are not specific, which is a challenge in the preoperative diagnosis. For cases with intussusception that was not observed in time, it may lead to intestinal necrosis and diffuse peritonitis. Additionally, the ruptured mucinous tumor in the appendix may lead to pathogenesis of pseudomyxoma peritonei. Therefore, accurate diagnosis and appropriate surgery-based treatment contribute to the improvement of prognosis and severe outcomes among these patients.

Blue Rubber Bleb Nevus Syndrome Complicated by Enhanced-Fibrinolytic-Type DIC: A Case Report.

A 54-year-old Japanese man was diagnosed with blue rubber bleb nevus syndrome (BRBNS) due to venodilation in the lower extremities at birth and gastrointestinal vascular malformations. He also had small bowel bleeding and enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC). Endoscopic sclerotherapy for intestinal hemangioma could not be performed because of bleeding concerns; instead, a combined anticoagulant and antifibrinolytic treatment was performed. Although combination treatment with unfractionated heparin and tranexamic acid proved ineffective for small bowel bleeding, combination treatment with apixaban and tranexamic acid dramatically improved enhanced-fibrinolytic-type DIC. In BRBNS, treatment strategies should be considered after performing detailed coagulation tests.

Emergency Surgery for Small Bowel Hemangioma. A review of the literature.

Background: Hemangiomas of the small intestine are tumors rarely found in practice. Patients usually present in emergency settings with anemia, gastrointestinal bleeding or abdominal pain. The purpose of this review of the literature is to evaluate the diagnostic modalities, therapeutic options and their results in cases of intestinal hemangiomas. Methods: This is a review of the recent literature concerning intestinal hemangioma with bleeding in the last five years including one case from our institution. Search criteria were defined using MeSH terms. The descriptive analysis was performed accordingly. Results: In the last five years there was a total of 24 cases ours being the 25th with a predominance of male patients (20 cases). Literature search found a low threshold for preoperative diagnostic (only in 28% of the cases). More than half of the tumors were in the ileum. Surgery is the main therapeutic option (in 88% of the cases). Nonsurgical treatment (endoscopic or radiological) can rarely be employed successfully. Conclusions: Surgery is the main treatment for larger hemangiomas while for smaller ones nonsurgical treatment methods are available.

S3453 Cavernous Hemangioma: A Rare Cause of Massive Lower Gastrointestinal Bleeding

INTRODUCTION: Hemangiomas are benign vascular tumors that rarely occur in the gastrointestinal tract. However, only 37 cases of small intestine hemangioma were reported from 2000 to 2018. Small bowel hemangiomas may cause massive lower gastrointestinal bleeding. In this report, we present a case of massive, and recurrent lower GI bleeding caused by a cavernous hemangioma of the small intestine. CASE DESCRIPTION/METHODS: A 32-year-old man came to the ER frequent episodes of large bloody bowel movements with a drop of Hb level, and he was transferred to MICU. The upper and lower endoscopy showed a large amount of blood with clots throughout the colon with no source of bleeding. A massive transfusion (of a total of 34 units) was given. Surgery and interventional radiology recommended Superior mesenteric artery arteriography, which demonstrated brisk bleeding from a jejunal branch overlying the left upper quadrant. Embolization of the bleeding jejunal branch was performed. A few days after, the patient developed other episodes of rectal bleeding. Capsule endoscopy revealed active small bowel bleeding, originating most likely from the proximal and mid-small intestine. Small intestine resection was performed, and the specimen analysis showed a cavernous hemangioma, measuring 1.2 × 1 × 0.8 cm. DISCUSSION: Hemangiomas are benign vascular neoplasms that can appear anywhere in the body, including the GIT, and it is considered as 0.05% of all gastrointestinal tumors. The jejunum is the most common site of occurrence. Hemangiomas may be solitary or multiple. Multiple hemangiomas are usually associated with the presence of similar lesions in other organs, such as liver and skin. Hemangiomas of GIT typically originate from the submucosal vascular plexus and extend from the submucosa to the muscular layer of the intestinal wall and they may extend beyond the serosa, involving the mesenteric, retroperitoneal, or pelvic fat. Histologically, hemangiomas classified into capillary, cavernous, and mixed. Initial investigations usually include upper and lower endoscopy. However, in most cases, these investigations are normal. CT angiography, MRI, radionuclide imaging, selective angiography, double-balloon enteroscopy, and capsule endoscopy could be used to identify the lesion. Surgical resection has conventionally been used for the treatment of intestinal hemangiomas. In recent years, less invasive therapeutic interventions, such as non-surgical endoscopic treatment and minimally invasive laparoscopic surgery, have become more common.

1966 Jejunal Submucosal Hemangioma as a Cause of Massive Gastrointestinal Bleeding: A Case Report

INTRODUCTION: Small intestinal hemangiomas are uncommon tumors that usually present with gastrointestinal bleeding (GIB). Hemangiomas account for only 0.05% of all intestinal tumors. The most common location in the small intestine is the mid-jejunum. Diagnosis, detection, and treatment can be challenging and may require surgery. CASE DESCRIPTION/METHODS: An 81-year-old female presented to the emergency department with a one-week history of melena, associated with fatigue and palpitations. She denied hematemesis, hematochezia, NSAIDs use, or the use of anticoagulants or antiplatelet agents. Her vital signs were stable, and her physical examination was unremarkable except for lower limb edema. Hemoglobin was 4.7 g/dl, which was lower than her baseline of 8 g/dl. The patient was transfused to maintain her hemoglobin above 7 g/dl, and a proton pump inhibitor infusion was initiated. Esophagogastroduodenoscopy was performed, and benign-appearing and non-bleeding polyps were detected in the gastric fundus and body. Colonoscopy did not detect significant abnormalities other than moderate diverticulosis, internal hemorrhoids and old melenic liquid throughout the colon but no active bleeding. Due to continued blood transfusion requirements, a video capsule endoscopy was performed, and active bleeding was detected. Push enteroscopy was performed, and a polypoid nodule with central umbilication and red spot was detected in the proximal jejunum [Figure 1]. The lesion was biopsied, and post-biopsy bleeding developed. Hemostasis was achieved by injection of epinephrine (1:10000 concentration) and application of three hemoclips. Subsequently, the patient underwent a laparoscopic segmental jejunal resection. Histologic examination of the resected specimen demonstrated a jejunal submucosal hemangioma with surrounding hemorrhage, an organizing hematoma, and no evidence of dysplasia or malignancy. DISCUSSION: Submucosal hemangiomas are a rare cause of GIB. They can present with melena and severe anemia. As the most common site is mid-jejunum, it is difficult to detect submucosal hemangiomas. In this case, the lesion was detected by video capsule endoscopy and was reached by push enteroscopy. Surgery is usually required for a definitive diagnosis and definitive treatment.

Infantile hemangioma as cause of neonatal gastrointestinal bleeding

Abstract Introduction Gastrointestinal infantile hemangiomas (IHs) are extremely rare and represent a diagnostic challenge, especially in newborns for the limited applicability of diagnostic approaches. We report two cases of neonates with gastrointestinal bleeding from intestinal hemangioma and a literature review of gastrointestinal IHs. Case 1: Full-term baby, asymptomatic at birth. On the seventh day of life she experienced failure to thrive, weight loss and hypotonus followed by melena and vomit. The imaging showed an intestinal vascular anomaly. We performed exploratory laparotomy and intestinal resection to remove the lesion. No complication occurred. Case 2: A 20-day old girl had melena and severe anaemia. The scintigraphic evaluation excluded gastric heterotopia. We opt for explorative surgery and we performed a laparoscopy that showed a congested and oedematous intestinal segment that was resected. Post-operative course was uneventful. Discussion Gastrointestinal IHs may cause intractable bleeding, intussusception and intestinal perforations with bad prognosis. A prompt and accurate diagnosis is vital but not always easy. Colour-coded Duplex Scan are a good first-line imaging, MRI and CT give a better definition but the latter exposes to radiation. In the “era” of minimally invasive surgery, laparoscopy can have a role in the management of patients with gastrointestinal IHs. Conclusions Gastrointestinal IHs should be considered in the differential diagnosis of neonates with anemia and gastro-intestinal bleeding. In selected cases, the minimally invasive approach permits diagnosis and treatment.

Small intestinal cavernous hemangioma causing chronic hemorrhage: a case report

Small intestinal hemangioma is a rare condition that can be divided histologically into capillary, cavernous or mixed types, among which the cavernous type is the most common. Here we report a case of small intestinal cavernous hemangioma with chronic hemorrhage in 44-year-old man. The patient complained of weakness and dizziness for 2 years that aggravated 1 month before admission accompanied by intermittent melena. Laboratory tests suggest severe anemia, and computed tomography, gastroscopy and colonoscopy all revealed signs of anemia. Capsule endoscopy detected small intestinal erosions, bleeding lesions and prominent neoplasms. An exploratory laparotomy was performed, in which the segment of the jejunum with lesions was resected. Pathological examination of the resected jejunum identified the neoplasm as cavernous hemangioma of the small intestine, which was the cause of severe anemia.

左上腹部圧痛で発症した小腸間膜静脈性血管腫の1例

左上腹部圧痛で発症した小腸間膜静脈性血管腫の1例

Cutaneous thoracic hemangioma and internal vascular anomalies

We report a male infant with a small thoracic strawberry hemangioma associated with other vascular anomalies: agenesis of the left vertebral artery and hypoplasia of the left carotid artery, and an intestinal hemangioma 45 cm in length removed at 1 1/2 months of age. He also had a severe aortic arch coarctation and ductus arteriosus. He died at the age of 4 months because of cardiac decompensation after surgical correction of the aortic arch coarctation. Neuroradiological study of the cerebral vessels and Central nervous system structures was not performed. Cardiac, aortic arch malformations and anomalies of the cerebral arteries are often associated with cutaneous hemangiomas, and all these features and may be some others define this syndrome.

Intestinal hemangioma presenting as recurrent hematochezia in a 6-week-old male

Abstract In infants, hematochezia must be approached with a broad differential diagnosis, including anal fissure, allergic colitis, Meckel's diverticulum, intestinal malrotation, necrotizing enterocolitis, and less commonly arteriovenous malformations, gastrointestinal duplications, and hemangiomas. Infantile hemangiomas, the most common tumor of infancy, are typically cutaneous lesions. Those arising from viscera are much less common but can cause significant morbidity and mortality if not diagnosed early and managed appropriately. We present a 6-week-old male with recurrent hematochezia who was initially diagnosed with milk protein intolerance but ultimately found to have a diffuse intestinal hemangioma. He was treated with propranolol, methylprednisolone, and exclusively parenteral nutrition. Repeat imaging suggested the lesion responded to pharmacotherapy and the patient is tolerating enteral nutrition.

Small bowel hemangiomas: Diagnostic role of capsule endoscopy

Vascular anomalies involving the small bowel are an uncommon cause of gastrointestinal bleeding in childhood. We present here an 11-year-old boy who presented with severe anemia and malena. The routine investigations did not reveal any pathology. A capsule endoscopy study was performed, which clinched the diagnosis and identified two intestinal hemangiomas. The hemangiomas were resected and the child recovered.

Hemangioma and vascular malformation of small intestine: a clinicopathologic analysis of fifty-one cases

To investigate the clinicopathologic features of small intestinal hemangioma and vascular malformation. A retrospective analysis was performed on 51 cases of hemangioma and vascular malformation involving the duodenum, jejunum and ileum in the past 30 years. The patient's age ranged from 1.4 to 75.0 years, with an average/median age of 40 years for the 51 cases. The ratio of male and female was almost equal. In most cases, the lesions were located in the ileum (18 cases) and jejunum (16 cases) accounting for 66.7%. The predominant symptoms and signs were either intestinal hemorrhage or obstruction. Grossly, the lesions appeared as polyp-like, ulcerative, varices, solitary mass, diffuse infiltration or in an occult status. Histologically, arteriovenous hemangioma also called arteriovenous malformation was more common seen accounting for 86.3%. Other less common vascular lesions included cavernous hemangioma, capillary hemangioma, Rendu-Osler-Weber syndrome and Dieulafoy disease. Histologic classification and denomination for hemangioma and vascular malformation of small intestine are still controversial. It is very important to correlate clinical manifestations with arteriography findings in histologic diagnosis of hemanigoma and vascular malformation of the small intestine.

An Infant with Kasabach-Merritt Syndrome with Associated Renal Hematoma and Intussusception

A neonate that had a forearm hemangioma, gross hematuria, and a renal parenchymal hematoma was found to have Kasabach-Merritt syndrome. He subsequently returned to our hospital and was found to have an intussusception secondary to an intestinal hemangioma.

Hemangiomas y malformaciones vasculares cutáneas y patología asociada (síndrome de Pascual-Castroviejo tipo II). Presentación de 41 pacientes

To describe the clinical, diagnostic and therapeutic features of this angiomatous neurocutaneous syndrome, which is the most frequent one, and to report a personal series of 41 patients. Forty one patients--31 females and 10 males--were studied during childhood and then, several patients were followed during many years, which allowed us to learn about the evolution of the abnormalities. The cutaneous lesions were classified as hemangiomas in 30 patients (73%) and as vascular malformations in 11 patients (27%). A cerebellar anomaly (unilateral hemispheric hypoplasia and Dandy-Walker malformation) was seen in 13 patients (31.5%) cerebral cortical dysplasia in 4 patients (10%), aortic arch coarctation in 6 patients (15%), and congenital cardiopathy in 5 patients (12%). The most frequent abnormalities were intracranial and/or extracranial vascular malformations. Persistence of the trigeminal artery was observed in 7 patients (17%), absence or severe hypoplasia of an internal carotid artery in 13 patients (32%), absence of a vertebral artery in 7 patients (17%), hypoplasia of intracranial arteries in 6 patients (15%) and aneurysmal enlargement of carotid or vertebral arteries in 5 patients (12%). Also were observed 4 patients (10%) with intracranial hemangioma, 2 (5%) with hemangioma in mediastinum, and 3 (7.5%) with intestinal hemangioma, all of which disappeared during the first years of life. Aneurysmal enlargement of the carotid and vertebral arteries and intracranial branches also disappeared after a process of progressive narrowing of the arterial lumen that caused complete obstruction of these arteries. At the same time the cutaneous hemangioma regressed. During this process, collateral vascularization through branches of the external carotid artery and of the non-affected branches of the contralateral intracranial arteries developed. This neurocutaneous syndrome is the most frequent one and it is associated with several types of vascular and non-vascular abnormalities which can involve any organ of the body. Internal and external hemangiomas and hemangiomatous lesions progress and tend to regress concomitantly.