Small Bowel Hemangioma Research Articles

Small bowel hemangioma causing perforation

Small bowel hemangioma causing perforation

Gastrointestinal: Small bowel hemangioma with unusual endoscopic findings and complicated with obscure gastrointestinal bleeding.

A 68-year-old woman was referred to our hospital for evaluation of severe anemia. Although she had an upper endoscopy and colonoscopy that failed to show the cause of her anemia, there was a small amount of blood in the terminal ileum, which suggested small bowel bleeding. In our hospital, video capsule endoscopy identified a spherically raised lesion in the jejunum, with central erosion of the surface mucosa, which was similar in morphology to a submucosal tumor (Fig. 1a). Balloon-assisted enteroscopy revealed a dark reddish, elevated lesion in the jejunum, the surface of which was extensively peeled off and thickly covered by blood clots (Fig. 1b). Malignant tumors such as angiosarcoma, gastrointestinal stromal tumor, and malignant lymphoma were suspected. A definitive preoperative diagnosis was difficult because of the unusual endoscopic findings. The patient underwent laparoscopic small bowel resection. The lesion was 17 mm in diameter (Fig. 2a). Histological findings revealed that the elevated lesion consisted of exposed vascular components, surrounded by normal small bowel mucosa, and numerous dilatated vessels without atypia were observed from the lamina propria to the muscularis propria. These findings were consistent with cavernous hemangioma (Fig. 2b,c). After surgery, the anemia improved within 6 months. Hemangiomas occur rarely in the small bowel. Thirteen cases of small bowel hemangiomas, observed preoperatively by enteroscopy, have been reported in adults. To the best of our knowledge, a submucosal tumor-like hemangioma with exposed vascular components is extremely rare and has been described in only one case. It was hypothesized that this uncommon morphology was formed by collapse of the tumor due to external stimuli such as small bowel peristalsis and food residue. This case highlights the unusual endoscopic appearance of small bowel hemangioma as a rare cause of obscure gastrointestinal bleeding.

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 Bowel Hemangioma Complicated with Obstruction

Small Bowel Hemangioma Complicated with Obstruction

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.

Emergency and Trauma Surgery.

According to the UEMS (Union Europeene des Medicins Specialises) Section of surgery Board of Surgery, "Emergency Surgery" can be defined "as surgery that is required to deal with an acute threat to life, organ, limb or tissue caused by external trauma, acute disease process, acute exacerbation of a chronic disease process, or complication of a surgical or other interventional procedure". Performance of emergency surgery require complex and varied skills and abilities to achieve procedures from different fields of surgery: abdominal, urologic, thoracic, vascular, soft tissue, skeletal) within an interval of 24 hours (1). In U.S., since 2008, Acute Care Surgery concept was introduced, and nowadays is an evolving specialty with three essential components- trauma, critical care and emergency surgery (2). In UK there is an increasing subspecialisation within general surgery over the last ten years. More recently, there has been an increase in focus on emergency general surgery (3,4). This may not come as a surprise given the fact that trafic crashes kill 1.2 million people annually around the world (3242 people/day) and 90% are in middle and low income countries. In US trauma is the leading cause of death in persons up to 40 years. Optimal care for emergency surgical patients is one of the major challenges for every healthcare system worldwide. An emergency surgery mai intervene during the daily schedule of elective interventions and create pressure on both the organisation and costs (5). Since it's birth, in 2007, the Romanian Society for Emergency Surgery and Trauma was involved in supporting the development of practice in emergency surgery in Romania by many actions: each year, during biannual National Congres and National Conference of the Romanian Society of Surgery 2 sessions were dedicated to emergency surgery, with invited foreign speakers; oragnisation of European Congres of Emergency and Trauma Surgery in 2017 in Bucharest, 1 tematic issue of Chirurgia Journal dedicated to surgery of the cirrhotic patients. This tematic isssue includes varia subjects from emergency surgery in valuable articles. The management of open abdomen management are depicted by Anastasiu et al, in a review summarizing definition, classification, indications, methods of temporary abdominal closure and fascial closure, and enterocutanous fistula. Turculet et al, perfomed a review of the litterature to describe the main advantages and disadvantages of the trauma systems in Europe and to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. A rare case of small bowel hemangioma with hemoperitoneum mimicking trauma is described by Iordache et al, with a review of the litterature. The series of reviews ends with an interesting article for daily practice in emergency hospitals about the diagnostic and therapeutic peculiarities in abdominal trauma associated with spinal cord injurie by Grigorean et al. Abdominal trauma is addressed in 7 original papers. The definitive surgery for liver trauma in tertiary HPB center, the nonoperative treatment of abdominal trauma involving liver and spleen, the timing of splenic interventional radiology, the management of colon trauma at a level II trauma, challenges raised by the retroperitoneal hematoma in abdominal trauma, predicition of evolution of patients with abdominal trauma using the usual biological parameters, and clinico-pathological correlations in the acute surgical abdomen in the pre and post COVID-19 pandemic period are presented, analysed and discussed in papers coming from specialized surgical units from Fundeni Clinical Institute, Emergency Clinical Hospital Bucharest, Emergency University Hospital of Bucharest, "Bagdasar-Arseni" Clinical Emergency Hospital, "St. Pantelimon" Clinical Emergency Hospital, Clinical County Emergency Hospitals of Craiova and Tg-Mures. The surgical technique of intraomental splenic implant and an attempt of reassessement is presented in a paper by Beuran et al. We hope that this tematic issue will be an interesting and very useful lecture for our readers and bring useful informations for those involved in emergency surgery.

Small bowel hemangioma in a 7-years-old boy, complicated by bleeding

Small intestine hemangioma is a benign vascular tumor formation, accounts for 0.05 to 0.3 % of all gastrointestinal tumors. This article presents a rare clinical observation - intraluminal hemangioma of distal parts of the ileum in a boy of 7 years old, complicated by massive bleeding. The presented clinical observation shows the difficulty of diagnosis, as well as the preliminary diagnosis performed by a pediatric surgeon: Meckel’s diverticulum, complicated by bleeding. As we know, more than 70 % of cases of gastrointestinal bleeding in children are really associated with the pathology of Meckel’s diverticulum. This requires the transfer of such patients to a surgical hospital, performing surgical intervention for revision of the abdominal cavity and excision of the pathological formation, as well as additional surgical techniques depending on intraoperative tactics.The described case demonstrates effective diagnostic tactics and features of intraoperative picture, surgical treatment of patient based on laparotomy and resection of intestinal area. The possibility of achieving encouraging results of surgical treatment of this difficult category of patients with reasonable choice of surgical tactics in childhood has been demonstrated. It is obvious that the key to successful treatment of such patients is timely diagnosis, which is not easy task due to the morphological and topographic characteristics of the pathological focus.

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.

Small-bowel hemangioma as a cause of chronic anemia.

Small intestine hemangiomas are benign vascular tumors that usually present with occult gastrointestinal bleeding. Endoscopic capsule and enteroscopy are two tools that help in your preoperative diagnosis.

Small-bowel hemangioma: rare and hard to find

Small-bowel hemangioma: rare and hard to find

Polidocanol injection therapy for small-bowel hemangioma by using double-balloon endoscopy

Small-bowel hemangioma is a rare disease that often causes active bleeding. The standard therapeutic method for small-bowel hemangioma is surgical resection. The aim of this study was to evaluate the usefulness of polidocanol injection (PDI) for small-bowel hemangiomas. This study included 12 patients with obscure GI bleeding (6 male; mean age 62 years) with 39 small-bowel hemangiomas; patients were treated with PDI by using double-balloon endoscopy (DBE). EUS with DBE was performed before PDI. The lesions were divided into 2 groups according to tumor size: Group A (size<10mm; 20 lesions) and group B (size≥10mm; 19 lesions). The outcomes of PDI treatment for small-bowel hemangioma were evaluated between the 2 groups. Additionally, in order to standardize the amount of PDI injected, the total amount of polidocanol according to lesion size was calculated. There was no difference in the location of lesions and treatment times between the 2 groups. Group B had a significantly higher injection time per lesion (P< .05) and amount of polidocanol per lesion than group A (P< .01). Rebleeding occurred in only 1 case (8%). There were no adverse events related to PDI. The contribution ratio between the lesion size and amount of polidocanol showed a correlation (r= 0.77). The optimal amount of polidocanol for small-bowel hemangioma was determined to be 0.2 mL/mm. PDI is an easy, safe, and effective method to treat small-bowel hemangiomas.

Single Cavernous Hemangioma of the Small Bowel Diagnosed by Using Capsule Endoscopy in a Child with Chronic Iron-Deficiency Anemia.

Cavernous hemangiomas of the gastrointestinal tract are extremely rare. In particular, the diagnosis of small bowel hemangiomas is very difficult in children. A 13-year-old boy presented at the outpatient clinic with dizziness and fatigue. The patient was previously diagnosed with iron-deficiency anemia at 3 years of age and had been treated with iron supplements continuously and pure red cell transfusion intermittently. Laboratory tests indicated that the patient currently had iron-deficiency anemia. There was no evidence of gross bleeding, such as hematemesis or bloody stool. Laboratory findings indicated no bleeding tendency. Gastroduodenoscopy and colonoscopy results were negative. To obtain a definitive diagnosis, the patient underwent capsule endoscopy. A purplish stalked mass was found in the jejunum, and the mass was excised successfully. We report of a 13-year-old boy who presented with severe and recurrent iron-deficiency anemia caused by a cavernous hemangioma in the small bowel without symptoms of gastrointestinal bleeding.

Small bowel cavernous hemangioma complicated with intussusception: report of an extremely rare case and review of literature.

Cavernous hemangioma of the small intestine is a rare disease in adult patients. Intussusception caused by small bowel hemangioma is extremely rare. We report a 20-year-old female presenting with lower abdominal pain and post-prandial bloating. Laboratory studies showed leukocytosis with left shifting and prominent anemia. Computed tomography of the abdomen revealed small bowel intussusception with bowel ischemia. Segmental resection of the intussuscepted jejunum was performed, and the diagnosis of cavernous hemangioma causing intussusception and anemia simultaneously was made.

Small Bowel Spindle Cell Capillary Type Hemangioma Diagnosed by Capsule Endoscopy in Elderly Female-A Rare Case Scenario

Purpose: A 65 year old female, with a past medical history of CABG, CAD with stents, diabetes mellitus and hypertension, was hospitalized for acute exertional chest pain and increasing shortness of breath over the past few months. She denied any history of hematochezia or melaena. Her clinical exam was essentially normal, except strongly hemo-occult positive stool. On admission, the patient's hemoglobin (Hgb) was 6.7 g/dl, hematocrit-20.2%, MCV-74.7 FL, RDW-16.8%. She received two units of PRBC. A comprehensive cardiac workup was normal. CT scan of abdomen and pelvis was normal. Upper endoscopy and colonoscopy did not reveal any source of bleeding. The patient was discharged on 9/6/11, with a Hgb of 10.7 g/dl, to be followed as outpatient. On her follow-up visit, her Hgb had decreased further at 9.9 g/dl. On subsequent capsule endoscopy, a small bowel ulcerated tumor was discovered in mid small bowel. On Ex-lap the lesion was found and resected. The pathology reported an ulcerated, lobulated spindle cell capillary type hemangioma, a rare tumor, primarily seen in pediatric patients. This case report highlights the importance and the benefits of capsule endoscopy in diagnosing small bowel tumors in elderly patients, often difficult to prepare for GI procedures, presenting with bleeding of unknown etiology. Small bowel hemangiomas are rare in the elderly1. Patients with hemangiomas can present with bleeding [acute or occult] or with perforation or obstruction.1 The most common hemangiomas of the GI tract are usually mixed type, usually of the cavernous type, rarely the capillary type 6. Ulcerated tumors can bleed slowly and cause microcytic hypochromic anemia. Capsule endoscopy is generally safe in the elderly, even in those with significant cardiac history and should be considered early in the work-up. Timely surgical intervention can prevent fatal complications like massive bleeding, obstruction and complications secondary to anemia.

Diffuse infantile hemangiomatosis of the ileum presenting with multiple perforations: a case report and review of the literature

Hemangiomas of the small intestine are rare, accounting for only 0.05% of all intestinal neoplasms (Jarvi et al. J Pediatr Gastroenterol Nutr. 2008;46:593-597). The jejunum is the most common site of involvement in the small intestine (Levy et al. Am J Roentgenol. 2001;177:1073-1081). Small bowel hemangiomas are most commonly manifested by gastrointestinal bleeding, abdominal pain, obstruction, or intussusception. There are very few reported cases in the literature of hemangiomatosis presenting with perforation, and only 1 previously reported case of perforation in the ileum. We present a rare case of a 5-week-old female with diffuse hemangiomatosis of the ileum presenting with multiple ileal perforations and peritonitis.

Solitary hemangioma of the small bowel disclosed by wireless capsule endoscopy

A nine-year-old child presented with melena and anemia. She had similar symptoms five months earlier and had undergone an extensive workup with upper gastrointestinal endoscopy and colonoscopy, both normal and 99m-Tc-RBC-scintigraphy which was positive in the right lower quadrant. This time, capsule endoscopy was performed and disclosed an hemangioma with a dark spot suggesting recent bleeding in the ileum. The lesion was resected. Pathological examination revealed a transmural cavernous hemangioma. Small bowel hemangioma is a rare disease. Its diagnosis is extremely difficult and is usually obtained during surgery. Capsule endoscopy is an endoscopic technique that can improve preoperative diagnosis, as reported in the present case.

Capsule endoscopy in Klippel - Trenaunay syndrome

A 53-year-old man, with known Klippel-Trenaunay syndrome (KTS), presented with massive life-threatening gastrointestinal blood loss. After hemodynamic resuscitation, upper endoscopy and ileocolonoscopy were performed. These did not reveal the source of bleeding. Video capsule endoscopy was subsequently performed using the Given (Yoqneam, Israel) system. This revealed a large number of small-bowel hemangiomas (Figure [1]). However, none of the lesions showed signs of active or recent bleeding. The clinical course was favorable, with spontaneous resolution of the blood loss. It remains unclear what may have precipitated the bleeding episode.

Small bowel hemangioma diagnosed with laparoscopy: Report of two pediatric cases

Hemangiomas of the small bowel are rare tumors that often present with gastrointestinal bleeding. Diagnosis can be difficult and exploratory laparotomy has often proved to be the only method with which to determine the presence and location of these tumors. We report two cases of small bowel hemangioma in children aged 10 and 7 years, in which the diagnosis was made by laparoscopy. Laparoscopy identifies the affected segment of bowel and allows delivery to a minimally extended umbilical port site. The avoidance of an open laparotomy helps to reduce post-operative analgesic requirement and achieves an early return of bowel function.

A patient with long-standing iron-deficient anemia

A 36-year-old Chinese woman presented with cutaneous lupus and was incidentally found to have iron-deficient anemia. She had a history of iron-deficient anemia 13 years previously, for which extensive investigations were carried out; the results of which were all normal. The patient also had pulmonary tuberculosis at that time, for which she received a full course of treatment. She required periodic blood transfusions and iron supplements to maintain her hemoglobin levels. She was subsequently discharged to a family clinic for follow-up until the current presentation. Upper endoscopy, colonoscopy, barium meal follow-through, small-bowel enema, (99m)Tc-labeled red-cell scan and double-balloon enteroscopy. Iron-deficient anemia due to obscure gastrointestinal bleeding caused by two small-bowel hemangiomas. Laparoscopic surgery.