Clin Endosc.  2015 Jul;48(4):340-344. 10.5946/ce.2015.48.4.340.

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

Affiliations
  • 1Department of Pediatrics, Jeju National University College of Medicine, Jeju, Korea. kskang@jejunu.ac.kr
  • 2Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea.
  • 3Department of Surgery, Jeju National University College of Medicine, Jeju, Korea.
  • 4Department of Pathology, Jeju National University College of Medicine, Jeju, Korea.

Abstract

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.

Keyword

Anemia, iron-deficiency; Hemangioma, cavernous; Capsule endoscopy; Child

MeSH Terms

Adolescent
Ambulatory Care Facilities
Anemia, Iron-Deficiency*
Capsule Endoscopy*
Child*
Colonoscopy
Diagnosis
Dizziness
Fatigue
Gastrointestinal Tract
Hemangioma
Hemangioma, Cavernous*
Hematemesis
Hemorrhage
Humans
Iron
Jejunum
Male
Iron

Figure

  • Fig. 1 (A, B) A purple-colored polypoid mass with surface bleeding in the jejunum was found by using capsule endoscopy.

  • Fig. 2 (A, B) The resected segment of the ileum showed a mass, 4.2×5.2 cm in size.

  • Fig. 3 Gross findings of the resected small intestine showed (A) an irregular ulceration with surface hemorrhage, and (B) spongy-like blood clot-filled spaces in the whole layer of the intestinal wall.

  • Fig. 4 Microphotographs of the lesion showed irregularly dilated vascular spaces in the submucosal and muscle layers (A, H&E stain, ×40) and blood-filled vascular structures lined by a single layer of endothelial cells (B, H&E stain, ×100).


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