1
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Nwagha TU, Okoye HC, Ugwu AO, Duru AN, Menuba IE, Ugwu EO, Ezebialu IU, Ugwu AO, Eze SC. Multidisciplinary approach to obstetric disseminated intravascular coagulopathy management in low-income country: A survey. Int J Gynaecol Obstet 2024. [PMID: 38940184 DOI: 10.1002/ijgo.15758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/08/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To assess the uptake of a multidisciplinary team approach in obstetric disseminated intravascular coagulopathy (DIC) management in a low- to middle-income country. METHODS A cross-sectional observational study, in which a semi-structured and pre-tested questionnaire was used to collect data on the uptake by Nigerian obstetricians of the multidisciplinary team approach to obstetric DIC management. RESULTS A total of 171 obstetricians responded, 82 (48.0%) were consultants and 89 (52.0%) were specialist registrars. Most (165; 96.5%) practiced in tertiary healthcare facilities and the multidisciplinary team approach was the most preferred (162; 94.7%) management approach. In all, 142 (83.0%) supported the invitation of hematologists always in the management whereas 115 (67.3%) participants recommended that involvement of specialists in the treatment should be when clinical presentation was suggestive of DIC. No significant association existed between years of obstetric practice and adoption of a multidisciplinary team-based approach (χ2 = 9.590; P = 0.252). CONCLUSION A multidisciplinary approach is widely adopted in the management of obstetric DIC, with hematologists being a key member of the team.
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Affiliation(s)
- Theresa U Nwagha
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Helen C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Angela O Ugwu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Augustine N Duru
- Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Ifeanyi E Menuba
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Emmanuel O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku Ozalla Campus, Enugu, Nigeria
| | - Ifeanyichukwu U Ezebialu
- Department of Obstetrics and Gynaecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Anambra State, Nigeria
| | - Aloysius O Ugwu
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Stephen C Eze
- Department of Obstetrics and Gynaecology, Federal Medical Center Abuja, Abuja, Nigeria
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2
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Rimondi A, Sorge A, Murino A, Nandi N, Scaramella L, Vecchi M, Tontini GE, Elli L. Treatment options for gastrointestinal bleeding blue rubber bleb nevus syndrome: Systematic review. Dig Endosc 2024; 36:162-171. [PMID: 37029779 DOI: 10.1111/den.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Blue rubber bleb nevus syndrome (BRBNS) is a rare challenging cause of gastrointestinal bleeding. We performed a systematic review of case reports and case series on BRBNS to gather information on the treatment options currently available. METHODS All studies reporting a case of BRBNS in humans were evaluated. Papers were ruled out if CARE criteria and explanations on patient's selection, ascertainment, causality, and reporting were not respected or identified. PROSPERO 2021 CRD 42021286982. RESULTS Blue rubber bleb nevus syndrome was treated in 106 cases from 76 reports. 57.5% of the population was under 18 years old, and up to 50% of the cases reported a previous treatment. Clinical success was achieved in 98 patients (92.4%). Three main types of interventions were identified: systemic drug therapy, endoscopy, and surgery. After BRBNS recurrence or previous therapy failure, systemic drug therapy emerged as a preferred second-line treatment over endoscopy (P = 0.01), but with a higher rate of reported adverse events when compared with surgery and endoscopy (P < 0.001). Endoscopic treatment was associated with a higher number of required sessions to achieve complete eradication when compared with surgery (P < 0.001). No differences between the three main areas were found in the overall follow-up time (P = 0.19) or in the recurrence rate (P = 0.45). CONCLUSION Endoscopy, surgery, and systemic drug therapy are feasible treatment options for BRBNS. Systemic drug therapy was the favorite second-line treatment after endoscopic failure or recurrence of BRBNS, but adverse events were more frequently reported.
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Affiliation(s)
- Alessandro Rimondi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Sorge
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
- Department of Gastroenterology, Cleveland Clinic London, London, UK
| | - Nicoletta Nandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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3
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Duong JT, Geddis A, Carlberg K, Rudzinski E, Len M, Zheng HB. Sirolimus for management of GI bleeding in blue rubber bleb nevus syndrome: A case series. Pediatr Blood Cancer 2022; 69:e29970. [PMID: 36094280 DOI: 10.1002/pbc.29970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 11/12/2022]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) commonly presents with anemia from bleeding gastrointestinal (GI) vascular malformations. Management is highly variable, as no consensus guidelines for medical treatment currently exist. Sirolimus has been used in BRBNS to decrease GI bleeding and seems well tolerated, though questions remain regarding dosing, duration of therapy, and adverse effects. Here, we report our single-center experience of four pediatric patients with BRBNS who were successfully treated with sirolimus and review the existing literature regarding sirolimus for treatment of GI bleeding in BRBNS. Further prospective studies are needed to establish optimal dosage, drug monitoring, and duration.
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Affiliation(s)
- Jennifer T Duong
- Department of Pediatrics, Division of Gastroenterology, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - Amy Geddis
- Department of Pediatrics, Division of Hematology/Oncology, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - Katie Carlberg
- Department of Pediatrics, Division of Hematology/Oncology, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - Erin Rudzinski
- Department of Pediatrics, Division of Pathology, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - Mary Len
- Department of Pediatrics, Division of Gastroenterology, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
| | - Hengqi B Zheng
- Department of Pediatrics, Division of Gastroenterology, Seattle Children's Hospital and University of Washington, Seattle, Washington, USA
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4
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Ma JX, Xia YC, Zou LP, Lin HJ, Chang X, Liu LY, Toledo JRA. Sirolimus as a promising drug therapy for blue rubber bleb nevus syndrome: Two-case report. SAGE Open Med Case Rep 2022; 10:2050313X221097755. [PMID: 35573101 PMCID: PMC9102151 DOI: 10.1177/2050313x221097755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Blue rubber bleb nevus syndrome is a very rare systemic vascular malformation frequently affecting the skin and the gastrointestinal tract. The pathogenesis of the disease is still unclear, and the standard treatment does not exist. This study reports two blue rubber bleb nevus syndrome cases, of which the second patient received the TEK gene mutations detection and got a low-dose sirolimus therapy, compared with the first patient who was not treated with sirolimus. The report shows some positive findings of TEK gene mutations and the efficacy of sirolimus treatment. We postulate that the TEK gene mutations play an important role in the pathogenesis. The mutations of different locations of the TEK gene cause a wide range of activating TIE2 mutations, which could stimulate the mammalian target of rapamycin signaling pathways to mediate angiogenesis, resulting in different clinical phenotypes of cutaneomucosal venous malformations. Sirolimus could effectively block the upstream and downstream factors of mammalian target of rapamycin signaling pathways to achieve the antiangiogenic effect. The initial dose of sirolimus can be 0.05–0.1 mg/kg/d for a trough level of 5–15 μg/L in the treatment of blue rubber bleb nevus syndrome. However, a lower-dose sirolimus is also effective while minimizing the side effects.
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Affiliation(s)
- Jian-Xun Ma
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - You-Chen Xia
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Heng-Ju Lin
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Xu Chang
- Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
| | - Li-Ying Liu
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Joy Roechelle A Toledo
- Department of Obstetrics and Gynecology, St. Joseph Mercy Hospital and Mercy Women's Center, Pontiac, MI, USA
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5
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Daviskiba S, Shuman H, Ayyash M, Vadlamudi G, Smietana S, Goyert G. A multidisciplinary approach to caring for a pregnant patient with blue rubber bleb nevus syndrome: A case report. Case Rep Womens Health 2022; 34:e00403. [PMID: 35299692 PMCID: PMC8920868 DOI: 10.1016/j.crwh.2022.e00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder characterized by recurrent, multifocal venous malformations throughout the skin, soft tissue, and numerous internal organs. Pregnant women with BRBNS are at high risk of morbidity and mortality, and thus their care requires careful planning and surveillance. This report highlights the case of a 21-year-old woman, gravida 1, para 0, with BRBNS who was cared for by a multidisciplinary team of providers in obstetrics, maternal-fetal medicine, obstetric anesthesia, hematology, dermatology, gastroenterology, and otorhinolaryngology. The report provides a comprehensive guide to the multidisciplinary management of pregnancy and delivery for patients with BRBNS. Blue rubber bleb nevus syndrome increases morbidity and mortality in pregnancy. Management requires a multidisciplinary approach to prenatal and intrapartum care. Careful planning and surveillance by multiple specialties is recommended.
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6
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Yang Y, Jia D, Jiang C. Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception-a case report and literature review. World J Surg Oncol 2022; 20:44. [PMID: 35193589 PMCID: PMC8864818 DOI: 10.1186/s12957-022-02519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cases with intussusception caused by either intestinal hemangiomas or appendiceal mucinous neoplasms are extremely rare. CASE PRESENTATION In 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. CONCLUSIONS Rare 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.
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Affiliation(s)
- Yanhua Yang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Dongmei Jia
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Chen Jiang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China.
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7
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Dooghaie Moghadam A, Bagheri M, Eslami P, Farokhi E, Nezami Asl A, Khavaran K, Iravani S, Saeedi S, Mehrvar A, Dooghaie-Moghadam M. Blue Rubber Bleb Nevus Syndrome because of 12 Years of Iron Deficiency Anemia in a Patient by Double Balloon Enteroscopy; A Case Report and Review of Literature. Middle East J Dig Dis 2021; 13:153-159. [PMID: 34712454 PMCID: PMC8531930 DOI: 10.34172/mejdd.2021.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/03/2021] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder comprised of venous malformation mostly involving the skin and gastrointestinal (GI) tract but can also involve other visceral organs. The most predominant site of GI tract involvement is the small bowel. In patients with GI lesions, treatment depends on the severity of bleeding, and extent of involvement. Conservative therapy with iron supplementation and blood transfusion is appropriate in cases with mild bleeding but in severe cases endoscopic and surgical interventions would be beneficial. Also, medical therapy with sirolimus significantly reduces bleeding. A 20-year-old woman was referred to our hospital after transfusion of six units of packed cell because of several episodes of lower GI bleeding within the past three months in the form of melena and a single episode of hematochezia. Her last hemoglobin level before admission was 10mg/dl. She underwent various unsuccessful investigations since she was eight years old to find the origin of refractory iron deficiency anemia. In upper endoscopy, five bleeding polypoid lesions were discovered in the jejunum. Lesions were excised by snare polypectomy. Over a six-month follow-up period, no signs of lower GI bleeding were noted and the patient had a normal hemoglobin level.
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Affiliation(s)
- Arash Dooghaie Moghadam
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagheri
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Eslami
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ermia Farokhi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Nezami Asl
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Karim Khavaran
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Shahrokh Iravani
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran.,Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Sandra Saeedi
- Gastroenterology and Hepatobiliary Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- Research Center for Cancer Screening and Epidemiology, AJA University of Medical Sciences, Tehran, Iran
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8
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AlNooh BM, AlQadri NG, Alghubayn M, AlAjlan SM. Sirolimus in the Management of Blue Rubber Bleb Nevus Syndrome: A Case Report and Review of the Literature. Case Rep Dermatol 2021; 13:417-421. [PMID: 34594200 PMCID: PMC8436651 DOI: 10.1159/000511535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare multifocal venous malformation (VM) that may affect any tissue or organ but mainly affects the skin, subcutaneous tissue and gastrointestinal (GI) tract. Patients present with serious anemia, treated with lifelong iron supplements and frequent blood transfusion secondary to chronic GI bleeding. Variable therapeutic modalities were used in the management of BRBNS; sirolimus (SRL), a mammalian target of rapamycin (mTOR) inhibitor, is found to be a promising therapy for vascular anomalies.
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Affiliation(s)
- Bayan Musaed AlNooh
- Department of Dermatology, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia
| | | | - Muhtadi Alghubayn
- Department of Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saad Mohammed AlAjlan
- Department of Dermatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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9
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Hult M, Halldorsdottir H, Vladic Stjernholm Y, Hein A, Jörnvall H. Blue Rubber Bleb Nevus Syndrome in the Obstetric Patient: A Case Report of Anesthetic Implications and Management. A A Pract 2021; 15:e01517. [PMID: 34428772 DOI: 10.1213/xaa.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic syndrome characterized by venous malformations usually found in the skin and visceral organs. To date, 11 case reports describing BRBNS during pregnancy have been published. To our knowledge, this is the first report describing intracranial, airway, epidural, and birth canal involvement of venous malformations in the same parturient. Key lessons learned include clinical presentation, workup, team management, and care of obstetric patients with this disorder.
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Affiliation(s)
- Martin Hult
- From the Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Halla Halldorsdottir
- Department of Anesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Vladic Stjernholm
- Department of Women's and Children´s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Hein
- Department of Anesthesia and Intensive Care, Danderyd University Hospital, Stockholm, Sweden
| | - Henrik Jörnvall
- From the Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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10
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Yang SS, Yang M, Yue XJ, Tou JF. Sirolimus treatment for neonate with blue rubber bleb nevus syndrome: A case report. World J Clin Cases 2021; 9:6929-6934. [PMID: 34447844 PMCID: PMC8362515 DOI: 10.12998/wjcc.v9.i23.6929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Blue rubber bleb naevus syndrome (BRBNS) is a rare disease that usually presents with multiple venous malformations in the skin and gastrointestinal tract. Lesions located in the gastrointestinal tract always result in chronic gastrointestinal bleeding and severe anemia. The successful management of BRBNS with sirolimus had been reported in many institutions, due to its impact on signaling pathways of angiogenesis. However, the experience in treatment of neonates with BRBNS was limited.
CASE SUMMARY A 38-day-old premature female infant born with multiple skin lesions, presented to our center complaining of severe anemia and hematochezia. Laboratory examination demonstrated that hemoglobin was 5.3 g/dL and contrast-enhanced abdominal computed tomography showed multiple low-density space-occupying lesions in the right lobe of the liver. She was diagnosed as having BRBNS based on typical clinical and examination findings. The patient was treated by transfusions twice and hemostatic drugs but symptoms of anemia were difficult to alleviate. A review of BRBNS case reports found that patients had been successfully treated with sirolimus. Then the patient was treated with sirolimus at an average dose of 0.95 mg/m2/d with a target drug level of 10-15 ng/mL. During 28 mo of treatment, the lesion was reduced, hemoglobin returned to normal, and there were no adverse drug reactions.
CONCLUSION This case highlights the dosing regimen and plasma concentration in neonates, for the current common empiric dose is high.
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Affiliation(s)
- Si-Si Yang
- Department of Neonatal Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Ming Yang
- Department of Burn and Plastic Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Jie Yue
- Department of Burn and Plastic Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Fa Tou
- Department of Neonatal Surgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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11
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Marakhouski K, Sharafanovich E, Kolbik U, Sautin A, Nikalayeva K, Pataleta A, Sanfirau K, Svirsky A. Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up: A case report. World J Gastrointest Endosc 2021; 13:90-96. [PMID: 33763189 PMCID: PMC7958468 DOI: 10.4253/wjge.v13.i3.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disease, difficult to diagnose and choose a treatment method, especially in young children. There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients, in general. The literature on BRBNS cases is limited and presents various therapeutic approaches.
CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female, whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam. Skin lesions, typical for BRBNS, appeared on the 8th d of the child’s life and their number increased over the next several months. The child also experienced episodes of critical decrease in hemoglobin level (by as much as 52 g/L) for several years, requiring iron supplementation and several blood transfusions. Video capsule endoscopy revealed numerous vascular formations in the small bowel. The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis. Single-balloon enteroscopy was used to perform sclerotherapy, with aethoxysklerol foam. A positive effect was observed within 19 mo of follow-up. We continue to monitor the patient’s hemoglobin level, every 2 wk, and it has remained satisfactory (> 120 g/L).
CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.
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Affiliation(s)
- Kirill Marakhouski
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Elena Sharafanovich
- Department of Elective Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Uladzislau Kolbik
- Department of Elective Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Aleh Sautin
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Katsiaryna Nikalayeva
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Aleh Pataleta
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Kiryl Sanfirau
- Diagnostic Division, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220113, Belarus
| | - Aliaksandr Svirsky
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
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12
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Hu Z, Lin X, Zhong J, He Q, Peng Q, Xiao J, Chen B, Zhang J. Blue rubber bleb nevus syndrome with the complication of intussusception: A case report and literature review. Medicine (Baltimore) 2020; 99:e21199. [PMID: 32664167 PMCID: PMC7360318 DOI: 10.1097/md.0000000000021199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Blue rubber bleb nevus syndrome (BRBNS) is an extremely rare disorder characterized by multifocal venous malformations involving various organs such as the skin and gastrointestinal tract. Severe complications of BRBNS, such as intussusception, volvulus, and intestinal infarction are rarer and require surgery. This report describes a 33-year-old male of BRBNS complicated with intussusception that was successfully diagnosed and treated with surgery. PATIENT CONCERNS A 33-year-old Chinese man presented with persistent, colicky pain accompanied by nausea, abdominal distension, and dizziness. The patient presented with sporadic bluish nodules on his skin involving his head, neck, thorax, abdomen, and planta pedis. DIAGNOSES BRBNS with the complication of intussusception. INTERVENTIONS An emergency laparotomy was performed, and postoperative management included blood transfusions and oral iron supplementation for 2 weeks. OUTCOMES The patient's postoperative course of hospitalization was uneventful. During the 4-month follow-up, the patient showed no signs of intussusception recurrence. LESSONS Patients diagnosed with BRBNS who present with acute abdominal pain and distension should raise suspicion for the presence of intussusception, which requires emergent surgical intervention.
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Affiliation(s)
- Zeming Hu
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Xuan Lin
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Jianing Zhong
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Qingfang He
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Qin Peng
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Jianbo Xiao
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Bin Chen
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Jianhong Zhang
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
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13
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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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14
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Wong XL, Phan K, Rodríguez Bandera AI, Sebaratnam DF. Sirolimus in blue rubber bleb naevus syndrome: A systematic review. J Paediatr Child Health 2019; 55:152-155. [PMID: 30565378 DOI: 10.1111/jpc.14345] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/23/2018] [Accepted: 11/18/2018] [Indexed: 12/14/2022]
Abstract
The aim of this study is to review sirolimus as a treatment for blue rubber bleb naevus syndrome (BRBNS). A literature search of Medline, Embase, CINAHL, SCOPUS and Google Scholar was conducted for publications reporting treatment of patients with BRBNS with sirolimus. Of 46 articles identified, 17 studies reporting 23 patients met inclusion criteria. Sirolimus was well tolerated in all but one patient who required treatment cessation; 17/18 patients noted an improvement in gastrointestinal disease where this was reported; 21/22 patients noted an improvement in cutaneous disease where this was reported. Based on these results, sirolimus may be considered a first-line treatment of BRBNS depending on patient morbidity.
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Affiliation(s)
- Xin Lin Wong
- University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | | | - Deshan F Sebaratnam
- University of New South Wales, Sydney, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Dermatology, Sydney Children's Hospitals' Network, Sydney, New South Wales, Australia
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15
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Barros FS, Marussi VHR, Amaral LLF, da Rocha AJ, Campos CMS, Freitas LF, Huisman TAGM, Soares BP. The Rare Neurocutaneous Disorders: Update on Clinical, Molecular, and Neuroimaging Features. Top Magn Reson Imaging 2018; 27:433-462. [PMID: 30516694 DOI: 10.1097/rmr.0000000000000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phakomatoses, also known as neurocutaneous disorders, comprise a vast number of entities that predominantly affect structures originated from the ectoderm such as the central nervous system and the skin, but also the mesoderm, particularly the vascular system. Extensive literature exists about the most common phakomatoses, namely neurofibromatosis, tuberous sclerosis, von Hippel-Lindau and Sturge-Weber syndrome. However, recent developments in the understanding of the molecular underpinnings of less common phakomatoses have sparked interest in these disorders. In this article, we review the clinical features, current pathogenesis, and modern neuroimaging findings of melanophakomatoses, vascular phakomatoses, and other rare neurocutaneous syndromes that may also include tissue overgrowth or neoplastic predisposition.
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Affiliation(s)
- Felipe S Barros
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Victor Hugo R Marussi
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Lázaro L F Amaral
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Antônio José da Rocha
- Division of Neuroradiology, Department of Radiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Christiane M S Campos
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Leonardo F Freitas
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruno P Soares
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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Tang X, Gao J, Yang X, Guo X. A 10-year delayed diagnosis of blue rubber bleb nevus syndrome characterized by refractory iron-deficiency anemia: A case report and literature review. Medicine (Baltimore) 2018; 97:e10873. [PMID: 29851802 PMCID: PMC6392564 DOI: 10.1097/md.0000000000010873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder consisting of multifocal venous malformations. Delayed diagnosis or misdiagnosis frequently occurs in patients without typical cutaneous lesions or gastrointestinal bleeding symptoms. This article reports a 10-year case of delayed diagnosis of BRBNS detected by capsule endoscopy. PATIENT CONCERNS AND DIAGNOSIS A 15-year-old girl presented with refractory iron-deficiency anemia (IDA) for 10 years, without any hemorrhagic signs or noticeable cutaneous lesions, which led to her obvious physical growth retardation. Capsule endoscopic examination revealed dozens of vascular blebs distributed from the jejunum to the ileum and a site of active bleeding. Hence, she was diagnosed with BRBNS. INTERVENTIONS Laparotomy was performed with resection of the small bowel lesions, and iron supplementation was prescribed for 3 months. Postoperatively, the patient had an uncomplicated course. OUTCOMES On follow-up after 3 years, IDA in this patient was cured and she did not require further blood transfusion and showed excellent vigor. LESSONS A high index of suspicion for BRBNS and adequate endoscopy examination will help to identify the origin of refractory IDA in older children, particularly in patients with vascular lesions of the skin.
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Affiliation(s)
- Xue Tang
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Ju Gao
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Xue Yang
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Xia Guo
- Department of Pediatrics, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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17
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Wang KL, Ma SF, Pang LY, Zhang MN, Hu LY, Liu MJ, Zou LP. Sirolimus alternative to blood transfusion as a life saver in blue rubber bleb nevus syndrome: A case report. Medicine (Baltimore) 2018; 97:e9453. [PMID: 29465551 PMCID: PMC5841973 DOI: 10.1097/md.0000000000009453] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations. The gastrointestinal bleeding and secondary iron deficiency anemia are the most common complications. There are currently no effective treatments for BRBNS. Here, we report a case of successful treatment with a small dose of sirolimus of a BRBN patient with a de novo gene mutation. PATIENT CONCERNS A 12-year-old female was admitted to our hospital with multiple hemangiomas for 12 years. The patient often displayed melena; she recently received transfusion of 2 units of red blood cells once every 2 weeks. Multiple fist-sized hemangiomas were piled up on both sides and back of the neck, and were also noted on the arms, legs, chest, back, and on the tip of the tongue. The laboratory findings demonstrated severe anemia. Blood sample sequencing detected a heterozygous de novo mutation c.2545C > Tin the TEK gene. DIAGNOSES Based on these findings, final diagnosis of Blue rubber bleb nevus syndrome (BRBNS) was made. INTERVENTIONS After the diagnosis, low-dose sirolimus was orally administered. OUTCOMES The patient's hemoglobin was increased after treatment with sirolimus for 1 month. Since the initial treatment with sirolimus, she had not received any blood transfusions. The skin and mucosal hemangioma decreased significantly, and new digestive tract hemorrhage, muscle hematoma, or adverse drug reactions were not observed. LESSONS we report a case of a mutation in exon 15 of the TEK gene leading to BRBN. It was successfully treated with a small dose of sirolimus as an alternative to blood transfusion in order to save the of BRBN patient's life.
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