J Korean Surg Soc.  2011 May;80(5):362-366. 10.4174/jkss.2011.80.5.362.

Hemorrhage from a jejunal polypoid hemangioma: single incisional laparoscopic approach

• Kye BH
• Kim SH
• Lee JI
• Kim JG
• Oh ST
• Kang WK
• Jung CK

• KMID: 2212162
• DOI: http://doi.org/10.4174/jkss.2011.80.5.362

Abstract

Bleeding lesions in the small bowel are a much more significant challenge in terms of detection and treatment than those of the stomach or the large bowel, and require extensive gastrointestinal evaluation before a diagnosis can be made. The authors report the case of an 81-year-old female patient who underwent small bowel segmental resection by single incisional laparoscopic approach for distal jejunalhemangioma, which caused severe anemia. An abdominal computed tomography scan demonstrated a highly enhancing polypoid tumor in the distal ileum. During the single incisional laparoscopic exploration using a 2 cm sized skin incision, jejuno-jejunal intussusceptions and a jejunal tumor were noted. Single incisional laparoscopy was performed to assist the jejunal segmental resection. Pathologic reports confirmed the lesion to be a jejunalhemangioma. The authors report an unusual case of jejunalhemangioma caused by intussusception and gastrointestinal hemorrhage, which was treated by single incisional laparoscopic surgery.

Keyword

Jejunal hemangioma; Single incision; Gastrointestinal hemorrhage

MeSH Terms

Aged, 80 and over
Anemia
Female
Gastrointestinal Hemorrhage
Hemorrhage
Humans
Ileum
Intussusception
Laparoscopy
Skin
Stomach

Figure

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  Fig. 1 Contrast enhanced CT scan shows ahighly enhancing polypoid tumor in the distal ileum. This lesion is considered to be the probable bleeding focus.

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  Fig. 2 This picture shows the 2-cm sized vertical transumbilical incision made to access the abdominal cavity.

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  Fig. 3 The small bowel lesion is presented as the intussusceptions of jejuno-jejunal type. The intussusceptum is about 2-3 cm diameter.

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  Fig. 4 The gross features of the jejunal mass. (A) Picture shows the 2-cm sized, pale brown, polypoid mass in the resected specimen. (B) Picture shows that the lesion has infiltrated the subserosa.

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  Fig. 5 Photomicrographs of the microscopic features of the jejunal mass. (A) The polypoid hemangioma consists of a proliferation of dilated vessels and small capillaries, and infiltrated proper muscle and subserosa (H&E stain, ×12). (B) The hemangioma consists of large blood-filled spaces or sinuses lined by single endothelial layers (H&E stain, ×100).

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