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Efficacy and Safety of Sirolimus for Blue Rubber Bleb Nevus Syndrome: A Prospective Study. Am J Gastroenterol 2021; 116:1044-1052. [PMID: 33416235 DOI: 10.14309/ajg.0000000000001117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic venous malformation (VM) disease. The characteristic gastrointestinal (GI) bleeding from multiple VM lesions causes severe chronic anemia which renders most patients depend on lifelong blood transfusion and frequent endoscopic treatment with dismayed outcomes. Although recent case reports suggest that oral sirolimus (rapamycin) is effective, a comprehensive evaluation of its efficacy and safety is in need. METHODS A prospective study was conducted for both pediatric and adult BRBNS patients with administration of sirolimus at the dose of 1.0 mg/m2 to maintain a trough concentration of 3-10 ng/mL. Laboratory tests including complete blood count, biochemical profile, D-dimer, and whole-body magnetic resonance imaging were performed at baseline and 3, 6, and 12 months after treatment. Clinical indicators such as hemoglobin level, lesion size, and transfusion need were evaluated. Adverse effects were recorded regularly. RESULTS A total of 11 patients (4 males and 7 females) with median age of 14 (range, 5-49) years were recruited. The average lesion size was reduced by 7.4% (P < 0.001), 9.3% (P < 0.001), and 13.0% (P < 0.05) at 3, 6, and 12 months of sirolimus treatment, respectively. Hemoglobin increased significantly after 6- and 12-month treatment (P = 0.006 and 0.019, respectively). Only 1 patient received blood transfusion once during the study. Patients' quality of life and coagulation function were improved. Grade 1-2 adverse effects including oral ulcers (81.8%), acne (27.3%), transient elevation of liver enzymes (18.2%), and hair loss (9.1%) were observed. DISCUSSION Sirolimus reduces the size of VMs, alleviates GI bleeding, and eliminates transfusion dependence of patients with BRBNS. The drug-related adverse effects are mild and mostly self-limited. These findings support sirolimus as a first-line treatment for GI and cutaneous VMs of BRBNS (see Visual abstract, Supplementary Digital Content, http://links.lww.com/AJG/B819).
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Quan X, Xu CD, Liu P, Zhang QQ, Chen Y, Wang L, Xiao Y. [Clinical effect of sirolimus in treatment of blue rubber bleb nevus syndrome in children: a report of 2 cases and literature review]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1011-1016. [PMID: 32933636 PMCID: PMC7499453 DOI: 10.7499/j.issn.1008-8830.2003171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
To study the clinical effect of oral sirolimus in the treatment of children with blue rubber bleb nevus syndrome (BRBNS) in the gastrointestinal tract, a retrospective analysis was performed on the clinical data and follow-up results of two children with BRBNS treated by sirolimus. The two children with BRBNS had gastrointestinal bleeding and anemia and were treated with sirolimus at a dose of 1 mg/day as part of treatment. The plasma concentration of the drug was maintained between 2.5-12.0 ng/mL. The children showed disappearance of gastrointestinal bleeding and improvements in anemia and coagulation function, and blood transfusion could be stopped during treatment, with no obvious adverse drug reactions. PubMed, Wanfang Data, and CNKI were searched for related articles on sirolimus in the treatment of BRBNS. A total of 26 cases of children with BRBNS, aged 0-18 years, were obtained. With the addition of the 2 cases in this study, sirolimus treatment achieved a satisfactory clinical effect in all 28 cases. Sirolimus may be effective and safe in the treatment of children with BRBNS, and further prospective studies are needed to evaluate the long-term efficacy of this drug.
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Affiliation(s)
- Xu Quan
- Department of Pediatrics, Ruijin Hospital North, Shanghai Jiao Tong University, School of Medicine, Shanghai 201821, China.
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Isoldi S, Belsha D, Yeop I, Uc A, Zevit N, Mamula P, Loizides AM, Tabbers M, Cameron D, Day AS, Abu-El-Haija M, Chongsrisawat V, Briars G, Lindley KJ, Koeglmeier J, Shah N, Harper J, Syed SB, Thomson M. Diagnosis and management of children with Blue Rubber Bleb Nevus Syndrome: A multi-center case series. Dig Liver Dis 2019; 51:1537-1546. [PMID: 31358484 DOI: 10.1016/j.dld.2019.04.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/10/2019] [Accepted: 04/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare, severe, sporadically occurring disorder characterized by multiple venous malformations. AIMS To present and analyze a case series of pediatric patients with BRBNS and to describe diagnostic approaches and management options applied. PATIENTS AND METHODS Multicenter, retrospective study, evaluating the diagnosis and management of children with BRBNS. RESULTS Eighteen patients diagnosed with BRBNS were included. Cutaneous venous malformations were observed in 78% and gastrointestinal venous malformations in 89%. Lesions were also found in other organs including muscles, joints, central nervous system, eyes, parotid gland, spine, kidneys and lungs. Gastrointestinal lesions were more common in the small intestine than in stomach or colon. The management varied significantly among centers. Endoscopic therapy and surgical therapy alone failed to prevent recurrence of lesions. In younger children and in patients with musculoskeletal or other organ involvement, sirolimus was used with 100% success rate in our series (5 patients treated) although poor compliance with subtherapeutic sirolimus trough levels led to recurrence in a minority. CONCLUSIONS Considering the multi-organ involvement in BRBNS, diagnosis and management requires a multidisciplinary approach. The treatment includes conservative, medical, endoscopic and surgical options. Prospective multicenter studies are needed to identify the optimal management of this rare condition.
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Affiliation(s)
- Sara Isoldi
- Centre of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom.
| | - Dalia Belsha
- Centre of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Intan Yeop
- Great Ormond Street Hospital, London, United Kingdom
| | - Aliye Uc
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Noam Zevit
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel Petach Tikva, Israel
| | - Petar Mamula
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Anthony Meneloas Loizides
- Department of Pediatrics, Albert Einstein College of Medicine, Division of Pediatric Gastroenterology and Nutrition, Children's Hospital at Montefiore, Bronx, NY, United States
| | - Merit Tabbers
- Departments of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Don Cameron
- Monash University and Southern Health, Parkville, Victoria, Australia
| | - Andrew S Day
- Department of Paediatrics, University of Otago (Christchurch), Christchurch, NZ, United States
| | - Marwa Abu-El-Haija
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Voranush Chongsrisawat
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Graham Briars
- Department of Paediatric Gastroenterology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | | | - Neil Shah
- Great Ormond Street Hospital, London, United Kingdom
| | - John Harper
- Institute of Child Health, University College London, United Kingdom
| | | | - Mike Thomson
- Centre of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
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Yang X, Wei M, Wang Z. A Rare Cause of Recurrent Hematochezia. Gastroenterology 2016; 150:568-9. [PMID: 26829300 DOI: 10.1053/j.gastro.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/04/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Deshpande GA, Samarasam I, George SV, Chandran S. Blue rubber bleb nevus syndrome: a rare cause of chronic gastrointestinal bleed in adults. Singapore Med J 2015; 55:e175-6. [PMID: 25631979 DOI: 10.11622/smedj.2014164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare condition characterised by venous malformations in the skin, gastrointestinal tract and other parts of the body. Its presentation is usually sporadic, although cases of autosomal dominant inheritance have been reported. Usually seen in children, BRBNS presentation in adults is rare. Symptoms at presentation depend on the organs involved; patients with BRBNS may present with acute or chronic gastrointestinal bleed. We herein report a rare presentation of BRBNS in an adult who suffered from intermittent abdominal pain and melaena for three years. Contrast-enhanced computed tomography revealed a jejunojejunal intussusception with a vascular malformation as the lead point. The patient underwent laparotomy with resection of the intussuscepted bowel segment. Recovery was uneventful. In spite of a wide range of therapeutic options for the management of BRBNS described in the literature, the efficacy of those available therapies, including surgical excision, is not well established.
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Affiliation(s)
- Gayatri Amit Deshpande
- Department of General Surgery, Upper Gastrointestinal Surgery Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India, 632 004.
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O'Kelly F, Lim KT, Ravi N, Mahmud N, Reynolds JV. The value of double balloon enteroscopy in diagnosing blue rubber bleb naevus syndrome: a case report. CASES JOURNAL 2010; 3:29. [PMID: 20157438 PMCID: PMC2821306 DOI: 10.1186/1757-1626-3-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 01/18/2010] [Indexed: 02/07/2023]
Abstract
Blue rubber bleb naevus syndrome is a rare vascular disorder associated with multiple gastrointestinal haemangiomas that have the potential for life-threatening haemorrhage. These may be difficult to diagnose, and have classically been described using computed tomographic studies and/or mesenteric angiography. Resected surgical specimens of these lesions, especially in the small bowel, have often been extensive and poorly localized. The recent advent and progressive development of double balloon enteroscopy has allowed the direct visualization and marking of these enteric lesions and serves as a valuable adjunct not only in diagnosis but also planning prior to surgery to allow accurate estimate of the extent of resection.
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Affiliation(s)
- Fardod O'Kelly
- Department of Clinical Surgery, Trinity Centre, St James's Hospital, Dublin 8, Ireland
| | - Kheng Tian Lim
- Department of Clinical Surgery, Trinity Centre, St James's Hospital, Dublin 8, Ireland
| | - Narayanasamy Ravi
- Department of Clinical Surgery, Trinity Centre, St James's Hospital, Dublin 8, Ireland
| | - Nasir Mahmud
- Department of Clinical Medicine, Trinity Centre, St James's Hospital, Dublin 8, Ireland
| | - John V Reynolds
- Department of Clinical Surgery, Trinity Centre, St James's Hospital, Dublin 8, Ireland
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Hasosah MY, Abdul-Wahab AA, Bin-Yahab SA, Al-Rabeaah AA, Rimawi MM, Eyoni YA, Satti MB. Blue rubber bleb nevus syndrome: extensive small bowel vascular lesions responsible for gastrointestinal bleeding. J Paediatr Child Health 2010; 46:63-5. [PMID: 19943859 DOI: 10.1111/j.1440-1754.2009.01619.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Blue Rubber Bleb Nevus Syndrome is a rare condition characterised by multiorgan venous malformations, in particular of cutaneous area and the gastrointestinal (GI) tract. We report here a child with chronic iron deficiency anaemia, melena and skin lesions. She had severe hypochromic microcytic anaemia. Upper and lower endoscopy revealed hundreds of red-bluish polypoid lesions involving the entire GI tract primarily of the small bowel. Due to localisation of the most severe lesions, the patient responded well to surgical treatment, allowing a sustained clinical remission.
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Affiliation(s)
- Mohammed Y Hasosah
- Department of Pediatric Gastroenterology, King Abdulaziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia.
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9
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Ng EKW, Cheung FKY, Chiu PWY. Blue rubber bleb nevus syndrome: treatment of multiple gastrointestinal hemangiomas with argon plasma coagulator. Dig Endosc 2009; 21:40-2. [PMID: 19691801 DOI: 10.1111/j.1443-1661.2008.00817.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Blue rubber bleb nevus syndrome is a rare clinical entity characterized by the formation of multiple blue or purplish rubbery cavernous hemangiomas on the skin and other epithelial surfaces. Involvement of the gastrointestinal tract is common and often presents with crippling anemia as a result of chronic occult blood loss. While surgical extirpation is an option for symptomatic hemangiomas in the intestine, endoscopic therapy is more appealing for lesions found in the stomach and colon. Here we report the successful use of argon plasma coagulation in the management of an adult with multiple hemangiomas in her colon and terminal ileum.
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Affiliation(s)
- Enders K W Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
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Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F. Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome: Report of a case and review of literature. World J Emerg Surg 2008; 3:3. [PMID: 18205939 PMCID: PMC2259327 DOI: 10.1186/1749-7922-3-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 01/18/2008] [Indexed: 01/10/2023] Open
Abstract
Background Blue rubber bleb naevus syndrome (BRBNS), is an uncommon condition characterised by cavernous haemangiomas of skin and gastrointestinal tract. The most common complication of this syndrome is gastrointestinal bleeding. Intussusception of bowel, although a known complication, has rarely been reported. Case presentation We report the case of a 37-year-old man who presented with multiple intussusceptions of small bowel. He required an urgent laparotomy and bowel resections. He suffered from BRBNS. This is the first reported case of multiple synchronous intussusceptions affecting both jejunum and ileum, secondary to haemangiomas occurring in an adult with BRBNS. The underlying conditions of acute abdomen in patients with BRBNS may include intramural haemorrhage, infarction, volvulus or intussusception of bowel. Treatment options include pharmacological manipulation, bowel resection, and interventions such as sclerotherapy, angiographic embolisation, endoscopic ligation, electrocautery and laser photocoagulation for visceral lesions. Conclusion A high index of suspicion is required whilst dealing with acute abdomen in patients with BRBNS. Clinical trials may provide some answers as to the preference of treatment in individual cases, as the current level of evidence does not offer a clear choice of optimal treatment.
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Affiliation(s)
- Clement Lee
- Department of Surgery, Newham University Hospital, Plaistow, London, E13 8SL, UK.
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De Bona M, Bellumat A, De Boni M. Capsule endoscopy for the diagnosis and follow-up of blue rubber bleb nevus syndrome. Dig Liver Dis 2005; 37:451-3. [PMID: 15893285 DOI: 10.1016/j.dld.2004.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 12/22/2004] [Indexed: 12/11/2022]
Abstract
Blue rubber bleb nevus syndrome is a rare disorder characterised by cutaneous and gastrointestinal vascular malformations. A 31-year-old man came under our observation with obscure gastrointestinal bleeding. Hemangiomas on his back and the multiple bluish vascular lesions in the distal ileum revealed by capsule endoscopy led to the diagnosis of blue rubber bleb nevus syndrome. The patient was treated with octreotide to prevent rebleeding. During the 12 months of treatment he had no gastrointestinal bleeding episodes or anaemia. Then repeat capsule endoscopy showed that the small bowel vascular lesions were unchanged. Capsule endoscopy may be a useful tool for diagnosing and monitoring the effects of therapy in patients with blue rubber bleb nevus syndrome.
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Affiliation(s)
- M De Bona
- Gastroenterology Unit, 'S. Maria del Prato' Hospital, Via Bagnols sur Ceze, 3, 32032 Feltre (Bl), Italy.
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Fishman SJ, Smithers CJ, Folkman J, Lund DP, Burrows PE, Mulliken JB, Fox VL. Blue rubber bleb nevus syndrome: surgical eradication of gastrointestinal bleeding. Ann Surg 2005; 241:523-8. [PMID: 15729077 PMCID: PMC1356993 DOI: 10.1097/01.sla.0000154689.85629.93] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We report the largest clinical experience to date of surgically treated patients with blue rubber bleb nevus syndrome (BRBNS). SUMMARY BACKGROUND DATA BRBNS is a rare congenital disorder presenting with multifocal venous malformations of the skin, soft tissues, and gastrointestinal (GI) tract. Patients with BRBNS develop anemia from chronic GI bleeding, and require lifelong treatment with iron and blood transfusions. An aggressive surgical approach to treat the GI venous malformations of BRBNS has been considered unlikely to be successful because of the large number of lesions, their position throughout the GI tract, and the likelihood of recurrence. Based on our belief that eradicated lesions would not recur, we undertook the removal of all GI tract lesions in an effort to eliminate bleeding. METHODS Ten patients with BRBNS were treated from 1993 to 2002. Lesions were identified using complete GI endoscopy. The multiple venous malformations were removed by a combination of wedge resection, polypectomy, suture-ligation, segmental bowel resection, and band ligation. RESULTS Patient ages ranged from 2 to 36 years, and patients received an average of 53 prior blood transfusions. A mean of 137 focal GI venous malformations per patient were resected at operation (range 4-557), with a mean operative duration of 14 hours (range 7-23 hours). Only 1 patient who had a less extensive procedure developed recurrent GI bleeding. The mean follow-up period was 5.0 years (range 2.9-10.3 years). CONCLUSIONS We believe that an aggressive excisional approach is indicated for the venous anomalies that cause GI bleeding in BRBNS.
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Affiliation(s)
- Steven J Fishman
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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Abstract
This article outlines the clinical, central nervous system, and neuropathologic features,pathogenesis, genetics, molecular biology, and neuroimaging characteristics of the rare vascular phakomatoses, melanophakomatoses, and organoid phakomatoses.
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Affiliation(s)
- Simon Edelstein
- Department of Radiology, MIA Group Limited Box Hill Hospital, Melbourne, Australia
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Nahm WK, Moise S, Eichenfield LF, Paller AS, Nathanson L, Malicki DM, Friedlander SF. Venous malformations in blue rubber bleb nevus syndrome: variable onset of presentation. J Am Acad Dermatol 2004; 50:S101-6. [PMID: 15097941 DOI: 10.1016/s0190-9622(03)02468-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by discrete venous malformations of varying size and appearance that are present on the skin and within the gastrointestinal tract. The characteristic cutaneous lesions consist of deep-blue, soft, rubbery blebs, which are easily compressible. A serious complication is gastrointestinal bleeding. Because venous malformations were described historically as cavernous hemangiomas, the lesions of BRBNS were also inappropriately called hemangiomas in the literature. We describe 3 cases to delineate the venous malformations of BRBNS and to highlight their variable onset of presentation and progression. In one case, a venous malformation was noted during a prenatal ultrasound evaluation at 5 months gestation. The other 2 cases demonstrated a lack of the classic cutaneous lesions at birth. BRBNS consists of multiple venous malformations, rather than hemangiomas as described. Subcutaneous venous malformations may occasionally be the sole presenting finding in patients with this unusual syndrome, and may be evident even in the prenatal period.
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Affiliation(s)
- Walter K Nahm
- Division of Dermatology, University of California-San Diego School of Medicine, San Diego, CA 92113, USA
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Teixeira MG, Perini MV, Marques CFS, Habr-Gama A, Kiss D, Gama-Rodrigues JJ. Blue rubber bleb nevus syndrome: case report. REVISTA DO HOSPITAL DAS CLINICAS 2003; 58:109-12. [PMID: 12845364 DOI: 10.1590/s0041-87812003000200009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The case of a patient with blue rubber bleb nevus syndrome who is infected by acquired immunodeficiency syndrome virus due to multiple blood transfusions is presented. This case shows that although it is a rare systemic disorder, blue rubber bleb nevus syndrome has to be considered in the differential diagnosis of chronic anemia or gastrointestinal bleeding. Patients should be investigated by endoscopy, which is the most reliable method for detecting these lesions. The patient underwent gastroscopy and enteroscopy via enterotomy with identification of all lesions. Minimal resection of the larger lesions and string-purse suture of the smaller ones involving all the layers of the intestine were performed. The string-purse suture of the lesions detected by enteroscopy proved to be an effective technique for handling these lesions, avoiding extensive intestinal resection and stopping the bleeding. Effective management of these patients demands aggressive treatment and should be initiated as soon as possible to avoid risks involved in blood transfusions, as occurred in this case.
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Affiliation(s)
- Magaly Gemio Teixeira
- Department of Gastroenterology, Division of Gastrosurgery and Coloproctology, Hospital das Clînicas, Faculty of Medicine, University of São Paulo, Brazil
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Dwivedi M, Misra SP. Blue rubber bleb nevus syndrome causing upper GI hemorrhage: a novel management approach and review. Gastrointest Endosc 2002; 55:943-6. [PMID: 12024162 DOI: 10.1067/mge.2002.124212] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Manisha Dwivedi
- Department of Gastroenterology, Moti Lal Nehru Medical College, Allababad, India
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Abstract
Blue rubber bleb nevus syndrome is a rare disorder characterized by distinctive cutaneous and gastrointestinal venous malformations that usually cause massive or occult gastrointestinal hemorrhage and iron deficiency anemia secondary to the bleeding episodes. It is even a rare cause of gastrointestinal hemorrhage during childhood. We describe a 6-year-old boy who had multiple venous malformations all over his body. He also suffered from several episodes of melena, chronic anemia, and growth retardation. The endoscopic examination of the gastrointestinal tract revealed multiple bluish-black sessile and polypoid venous malformations in various sizes. It was possible to remove the largest venous malformations causing massive bleeding during colonoscopy.
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Affiliation(s)
- D Ertem
- Marmara University School of Medicine, Division Pediatric Gastroenterology and Nutrition, Tophanelioglu Cd. 13-15, 81190 Altunizade-Istanbul, Turkey.
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Romão Z, Pontes J, Lopes H, Vasconcelos H, Portela F, Andrade P, Leitão MC, Donato A, Freitas D. Endosonography in the diagnosis of "blue rubber bleb nevus syndrome": an uncommon cause of gastrointestinal tract bleeding. J Clin Gastroenterol 1999; 28:262-5. [PMID: 10192619 DOI: 10.1097/00004836-199904000-00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Blue rubber bleb nevus syndrome is a rare condition characterized by the presence of multiple angiomatic lesions of the skin. These are associated with similar lesions in other organs, namely in the gastrointestinal tract, causing anemia through chronic bleeding. We describe the case of a 72-year-old woman with microcytic anemia. A barium study revealed irregular lacunae in the distal esophagus. A subsequent endoscopy showed blue nodular lesions similar to angiomas of the esophagus and stomach fundus. Endosonography confirmed its angiomatic nature. Exploration of other organs, using magnetic resonance and cranial computed tomography, did not reveal the presence of this type of lesion. In physical examination, two angiomatic lesions were observed on the face and lips, respectively. These were blue in color and compressible, leaving an empty wrinkled sac that rapidly refilled, typical of angiomas.
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Affiliation(s)
- Z Romão
- Department of Gastroenterology, Coimbra University Hospital, Portugal
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Goraya JS, Marwaha RK, Vatve M, Trehan A. Blue rubber bleb nevus syndrome: a cause for recurrent episodic severe anemia. Pediatr Hematol Oncol 1998; 15:261-4. [PMID: 9615325 DOI: 10.3109/08880019809028794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 7-year-old boy had several episodes of severe anemia, requiring hospitalizations and blood transfusions. Skin hemangiomas characteristic of blue rubber bleb nevus syndrome were present since infancy, but were not recognized as being indicative of simultaneous existence of bowel hemangiomas, resulting in a delay of several years before an accurate diagnosis could be made.
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Affiliation(s)
- J S Goraya
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shimada S, Namikawa K, Maeda K, Obata S, Ikei S, Mizutani J, Ogawa M. Endoscopic polypectomy under laparotomy throughout the alimentary tract for a patient with blue rubber bleb nevus syndrome. Gastrointest Endosc 1997; 45:423-7. [PMID: 9165328 DOI: 10.1016/s0016-5107(97)70157-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S Shimada
- Department of Surgery II, Kumamoto University School of Medicine, Japan
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Affiliation(s)
- L Laine
- GI Division, University of Southern California School of Medicine, Los Angeles 90033
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Morris L, Lynch PM, Gleason WA, Schauder C, Pinkel D, Duvic M. Blue rubber bleb nevus syndrome: laser photocoagulation of colonic hemangiomas in a child with microcytic anemia. Pediatr Dermatol 1992; 9:91-4. [PMID: 1603744 DOI: 10.1111/j.1525-1470.1992.tb01220.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This is a case report and review of the literature on the blue rubber bleb nevus syndrome. The clinical features of the syndrome are discussed, with emphasis on chronic gastrointestinal bleeding and resulting anemia. A new therapeutic modality, colonoscopy with laser photocoagulation, is recommended as a safe, effective, and less invasive method of controlling bleeding from colonic hemangiomas than surgical resection and repeated transfusions. This technique is less helpful for patients with prominent involvement of the small intestine.
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Affiliation(s)
- L Morris
- Department of Dermatology, University of Texas Medical School, Houston 77030
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Abercrombie JF, Jeffrey I, Staunton MD. Peerless Haemangiomata. Med Chir Trans 1992; 85:300. [PMID: 1433100 PMCID: PMC1294615 DOI: 10.1177/014107689208500522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gallo SH, McClave SA. Blue rubber bleb nevus syndrome: gastrointestinal involvement and its endoscopic presentation. Gastrointest Endosc 1992; 38:72-6. [PMID: 1612387 DOI: 10.1016/s0016-5107(92)70339-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S H Gallo
- Department of Medicine, University of Louisville School of Medicine, Kentucky
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Sumi Y, Taguchi N, Kaneda T. Blue rubber bleb nevus syndrome with oral hemangiomas. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 71:84-6. [PMID: 1994329 DOI: 10.1016/0030-4220(91)90528-k] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of blue rubber bleb nevus syndrome with oral hemangiomas is reported. Attention is directed to this syndrome because, although rare, it is usually associated with oral lesions. The blue rubber bleb nevus syndrome should always be considered a possibility in patients with oral hemangiomas and bluish skin nodules.
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Affiliation(s)
- Y Sumi
- Department of Oral and Maxillofacial Surgery, Komaki City Hospital
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26
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