1
|
Kozai L, Nishimura Y. Clinical characteristics of blue rubber bleb nevus syndrome in adults: systematic scoping review. Scand J Gastroenterol 2023; 58:1108-1114. [PMID: 37211745 DOI: 10.1080/00365521.2023.2214263] [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: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic vascular anomaly mainly affecting the skin, central nervous system and gastrointestinal tracts. Its clinical presentation and characteristics in adult patients are unclear. AIM To clarify the characteristics of BRBNS in adult patients with a focus on gastrointestinal symptoms. METHODS Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including 'Blue rubber bleb nevus syndrome' from their inception to 28 December 2021. RESULTS Ninety-nine articles, including 3 observational studies and 101 cases from case reports and series, were included. Observational studies were consistently with small sample sizes, and there was only one prospective study to show the effectiveness of sirolimus in BRBNS. Common clinical presentations included anemia (50.5%) and melena (26.5%). While skin findings were known to be representative of BRBNS, only 57.4% had known vascular malformation. The diagnosis was primarily made clinically, with only 1% being diagnosed with BRBNS through genetic sequencing. Distribution of BRBNS-related lesions were variable, but predominantly oral (55.9%), followed by small bowel (49.5%), colorectal (35.6%) and stomach (26.7%) vascular malformations. CONCLUSION While it has been underrecognized, adult BRBNS could be a culprit for refractory microcytic anemia or occult gastrointestinal bleeding. Further studies are critical to establish a uniform understanding of diagnosis and treatment for those with adult BRBNS. The utility of genetic testing in adult BRBNS diagnosis and the patient characteristics that may benefit from sirolimus, a potentially curative agent, remain to be clarified.
Collapse
Affiliation(s)
- Landon Kozai
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| |
Collapse
|
2
|
Khan QA, Farkouh C, Khan A, Uddin Z, Abdi P, R Anthony M, Hadi FA, Khan E, Parvez S. Blue Rubber Bleb Nevus Syndrome Presenting as Anemia, Hemorrhage, and Hemangiomas: A Rare Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231173503. [PMID: 37205005 PMCID: PMC10186580 DOI: 10.1177/11795476231173503] [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: 02/23/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023]
Abstract
Background Blue Rubber Bleb Nevus syndrome (BRBNS) is a rare disorder, that results in congenital cutaneous hemangiomas of the skin and gastrointestinal tract. Although asymptomatic, the nevi present as soft, non-mobile, dark blue, compressible papules. Clinically it presents as iron deficiency anemia due to occult gastrointestinal bleeding. Case presentation A 22-year-old female patient presented with complaints of shortness of breath, fatigue, and palpitation for 2 months. On examination, she had a pale effect and widespread hemangiomas on her lips, hands, and feet. Laboratory results revealed iron deficiency anemia with hemoglobin (Hb) of 2.1 gm/dl and histopathology results of the hemangioma specimen showed angiokeratomas. Based on clinical manifestations and laboratory results, the patient was diagnosed with a case of BRBNS. The patient was transfused with red cell concentrate her symptoms improved but on the first follow-up visit her Hb again dropped to 8.6 mg/dl. Conclusion A high suspicion of BRBNS diagnosis should be considered if a patient presents with iron deficiency anemia and multiple cutaneous hemangiomas. Further screening should be done to explore internal bleeding and hemangiomas.
Collapse
Affiliation(s)
| | | | - Arooba Khan
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
| | - Zahir Uddin
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
| | - Parsa Abdi
- Memorial University, St. Johns, NL,
Canada
| | | | | | - Eyan Khan
- Khyber Medical College, Peshawar,
Pakistan
| | - Sara Parvez
- Khyber Teaching Hospital MTI KTH,
Peshawar, Pakistan
| |
Collapse
|
3
|
Nitta K, Matsui A, Araki A, Kikuchi D, Hoteya S. Clipping with double-balloon endoscopy for small intestinal venous malformations in a patient with blue rubber bleb nevus syndrome. Clin J Gastroenterol 2022; 15:901-906. [DOI: 10.1007/s12328-022-01670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
|
4
|
Unoura S, Toya Y, Kasugai S, Kumei T, Yamazato M, Sasaki Y, Eizuka M, Oizumi T, Morishita T, Tagane S, Shiohata T, Yanai S, Akasaka M, Matsumoto T. Successful endoscopic sclerotherapy with bile duct stenting for a vascular malformation neighboring the duodenal papilla in blue rubber bleb nevus syndrome. DEN OPEN 2022; 2:e113. [PMID: 35873521 PMCID: PMC9302048 DOI: 10.1002/deo2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 06/15/2023]
Abstract
A 14-year-old girl, who had been diagnosed with blue rubber bleb nevus syndrome, was referred to our hospital because of iron deficiency anemia. Esophagogastroduodenoscopy revealed a dark and red-colored vascular malformation occurring just above the duodenal papilla. Because the lesion was regarded as the cause of the anemia, we performed polidocanol injection therapy with bile duct stenting. Since esophagogastroduodenoscopy performed a month later revealed a scarred ulcer, the bile duct stent was removed. She has been under observation as an outpatient without any symptoms.
Collapse
Affiliation(s)
- Shingo Unoura
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Yosuke Toya
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Satoshi Kasugai
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Tomo Kumei
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Masanao Yamazato
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Yutaka Sasaki
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Makoto Eizuka
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Tomofumi Oizumi
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Toshifumi Morishita
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Seiya Tagane
- Department of PediatricsSchool of MedicineIwate Medical UniversityIwateJapan
| | - Takeshi Shiohata
- Department of PediatricsSchool of MedicineIwate Medical UniversityIwateJapan
| | - Shunichi Yanai
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Manami Akasaka
- Department of PediatricsSchool of MedicineIwate Medical UniversityIwateJapan
| | - Takayuki Matsumoto
- Department of Internal MedicineDivision of GastroenterologySchool of MedicineIwate Medical UniversityIwateJapan
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Aoyama T, Fukumoto A, Shigita K, Asayama N, Mukai S, Nagata S. Successful Endoscopic Sclerotherapy Using Polidocanol for Small Bowel Hemangioma. Intern Med 2020; 59:1727-1730. [PMID: 32238724 PMCID: PMC7434551 DOI: 10.2169/internalmedicine.4327-19] [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: 12/18/2022] Open
Abstract
Small-bowel hemangiomas are a possible source of gastrointestinal bleeding for which there is no established treatment approach. In this report, we describe the case of a 58-year-old woman who presented with hematochezia and who was diagnosed with small bowel hemangioma. She was successfully treated using endoscopic sclerotherapy. Initial capsule endoscopy revealed bleeding in the ileum. Subsequent double-balloon enteroscopy showed a 2-cm, bluish-purple, ileal submucosal tumor with an overlying protrusion. The lesion was responsible for the hematochezia and was treated with intralesional injection of polidocanol. The hematochezia completely resolved and at 4 months after sclerotherapy, the size of the lesion was significantly reduced.
Collapse
Affiliation(s)
- Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Akira Fukumoto
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Kenjiro Shigita
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Naoki Asayama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Shinichi Mukai
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Polidocanol injection therapy for small-bowel hemangioma by using double-balloon endoscopy. Gastrointest Endosc 2016; 84:163-7. [PMID: 26907744 DOI: 10.1016/j.gie.2016.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/10/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS 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. METHODS 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 <10 mm; 20 lesions) and group B (size ≥10 mm; 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. RESULTS 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. CONCLUSIONS PDI is an easy, safe, and effective method to treat small-bowel hemangiomas.
Collapse
|
10
|
Ning S, Zhang Y, Zu Z, Mao X, Mao G. Enteroscopic sclerotherapy in blue rubber bleb nevus syndrome. Pak J Med Sci 2015; 31:226-8. [PMID: 25878650 PMCID: PMC4386193 DOI: 10.12669/pjms.311.5858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/26/2014] [Indexed: 12/12/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare syndrome characterized by multiple vascular malformations of varying size and appearance that present predominantly on the skin and within the gastrointestinal tract and, less often, in other internal organs. Gastrointestinal lesions of BRBNS can cause acute or chronic bleeding, and the treatment is challenging. In this case, we reported a successful treatment of vascular malformations in all segments of gastrointestinal tract, including the small intestine, by endoscopic sclerotherapy, in a 10-year-old boy with BRBNS.
Collapse
Affiliation(s)
- Shoubin Ning
- Shoubin Ning, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Yafei Zhang
- Yafei Zhang, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Zhanfei Zu
- Zhanfei Zu, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Xuyan Mao
- Xuyan Mao, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| | - Gaoping Mao
- Gaoping Mao, Department of Gastroenterology, General Hospital of Air Force, PLA, Beijing, China
| |
Collapse
|
11
|
Saeed ID, Kheroo KN, Abdullah TJ, Salih KA. Blue rubber bleb naevus syndrome: a rare cause of iron deficiency anaemia. BMJ Case Rep 2014; 2014:bcr-2014-205144. [PMID: 25388891 DOI: 10.1136/bcr-2014-205144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We report a case in an adolescent male patient with a history of chronic fatigue, headache and unexplained iron deficiency anaemia since 2007. Numerous bluish-black lesions were found over his body surface. A surgical scar from a previous lumpectomy with a small lump were noted at the left submandibular region and another smaller lesion on the left lobe of the thyroid was also palpated. His most recent blood indices displayed the presence of moderately severe iron deficiency anaemia. Endoscopic evaluation exhibited multiple vascular lesions throughout the gastrointestinal tract. MRI of the brain revealed an irregular intracranial vascular lesion at the cerebellopontine angle. Further work-up with abdominal CT demonstrated the absence of similar lesions in the extraintestinal abdominal organs. Putting these together with histological findings, the diagnosis of blue rubber bleb naevus syndrome was confirmed. The patient was treated conservatively at this point and future management planning was discussed with him.
Collapse
Affiliation(s)
- Ismail D Saeed
- Department of Medicine, Mosul College of Medicine, Mosul, Iraq
| | - Khalid N Kheroo
- Department of Medicine, Mosul College of Medicine, Mosul, Iraq
| | | | | |
Collapse
|
12
|
A rare cause of gastrointestinal bleeding: endoscopic venous malformations, but not vasculitis. Clin Res Hepatol Gastroenterol 2013; 37:224-5. [PMID: 23518296 DOI: 10.1016/j.clinre.2013.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 02/06/2013] [Indexed: 02/04/2023]
|
13
|
Ide K, Uchida N, Iyori K, Mochizuki T, Fukushima R, Iwasaki T, Nishifuji K. Multi-system progressive angiomatosis in a dog resembling blue rubber bleb nevus syndrome in humans. J Small Anim Pract 2013; 54:201-4. [PMID: 23496103 DOI: 10.1111/jsap.12034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A six-year-old, neutered, female golden retriever was presented with generalised, dark purple to black cutaneous nodules and gastrointestinal haemorrhage. Histopathologically, all cutaneous nodules were diagnosed as benign cavernous haemangiomas. Endoscopic analysis revealed similar nodules in the oesophagus, stomach and duodenum. At laparotomy, similar nodules were seen on the visceral peritoneal lining of abdominal organs. Metastatic haemangiosarcoma was ruled out based on histological features and lack of primary tumour in spleen, liver or heart ultrasonographically. Blood loss associated with gastrointestinal haemorrhage was managed with blood transfusion. To the authors' knowledge, this is the first canine case of multi-system progressive angiomatosis resembling blue rubber bleb nevus syndrome in humans.
Collapse
Affiliation(s)
- K Ide
- Laboratory of Veterinary Internal Medicine, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo, 183-8509, Japan
| | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Blue rubber bleb nevus syndrome is a rare disorder that is characterized by multiple recurrent vascular malformations, such as hemangioma, and these primarily involve the skin and the gastrointestinal tract. It may also involve the brain, liver, lungs, and skeletal muscles. A 14-year-old female visited our hospital with a chief complaint of dizziness; upon examination, we found multiple recurrent hemangiomas on the skin and gastrointestinal tract. We were able to diagnose her as suffering from blue rubber bleb nevus syndrome and we treated her with methylprednisolone (2 mg/kg/day for 1 month and 1 mg/kg/day for additional 3 months). We report on this case along with a review of the literature.
Collapse
Affiliation(s)
- Seung Hwan Shin
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
15
|
Vascular Malformation and Hemangiomatosis Syndromes: Spectrum of Imaging Manifestations. AJR Am J Roentgenol 2008; 190:1291-9. [DOI: 10.2214/ajr.07.2779] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
16
|
Mechri M, Soyer P, Boudiaf M, Duchat F, Hamzi L, Rymer R. Small bowel involvement in blue rubber bleb nevus syndrome: MR imaging features. ACTA ACUST UNITED AC 2008; 34:448-51. [DOI: 10.1007/s00261-008-9395-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Kishikawa H, Okada Y, Kawahara T, Saito K, Tanaka Y. A case of blue rubber bleb nevus syndrome treated by etidronate. J Bone Miner Metab 2007; 25:138-41. [PMID: 17323184 DOI: 10.1007/s00774-006-0740-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 11/09/2006] [Indexed: 01/10/2023]
Affiliation(s)
- Hirofumi Kishikawa
- First Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | | | | | | | | |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- M De Bona
- Gastroenterology Unit, 'S. Maria del Prato' Hospital, Via Bagnols sur Ceze, 3, 32032 Feltre (Bl), Italy.
| | | | | |
Collapse
|
19
|
Cappell MS. From Colonic Polyps to Colon Cancer: Pathophysiology, Clinical Presentation, and Diagnosis. Clin Lab Med 2005; 25:135-77. [PMID: 15749236 DOI: 10.1016/j.cll.2004.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epidemiologists, basic researchers, clinicians, and public health administrators unite! Develop and implement a simple, safe, and effective preventive and screening test for colon cancer. The public will willingly and enthusiastically accept such a test. Many thousands of lives are at stake every year.
Collapse
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA.
| |
Collapse
|
20
|
Cappell MS. The pathophysiology, clinical presentation, and diagnosis of colon cancer and adenomatous polyps. Med Clin North Am 2005; 89:1-42, vii. [PMID: 15527807 DOI: 10.1016/j.mcna.2004.08.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A review of the pathophysiology, clinical presentation, and diagnosis of colon cancer and colonic polyps is important and timely. This field is rapidly changing because of breakthroughs in the molecular basis of carcinogenesis and in the technology for colon cancer detection and treatment. This article reviews colon cancer and colonic polyps, with a focus on recent dramatic advances, to help the pri-mary care physician and internist appropriately refer patients for screening colonoscopy and intelligently evaluate colonoscopic findings to reduce the mortality from this cancer.
Collapse
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141-3098, USA.
| |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Simon Edelstein
- Department of Radiology, MIA Group Limited Box Hill Hospital, Melbourne, Australia
| | | | | |
Collapse
|
22
|
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.
Collapse
Affiliation(s)
- Walter K Nahm
- Division of Dermatology, University of California-San Diego School of Medicine, San Diego, CA 92113, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
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.
Collapse
Affiliation(s)
- Magaly Gemio Teixeira
- Department of Gastroenterology, Division of Gastrosurgery and Coloproctology, Hospital das Clînicas, Faculty of Medicine, University of São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
24
|
Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am 2002; 86:1253-88. [PMID: 12510454 DOI: 10.1016/s0025-7125(02)00077-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Flexible sigmoidoscopy and colonoscopy have revolutionized the clinical management of colonic diseases. Colonoscopy is a highly sensitive and specific test. Colonic diseases often produce characteristic colonoscopic findings, as well as characteristic histologic findings, as identified in colonoscopic biopsy or polypectomy specimens. Colonoscopy is relatively safe, with a low incidence of serious complications, such as colonic perforation, hemorrhage, cardiopulmonary arrest, or sepsis. Colonoscopy is becoming more important clinically because of more widespread use of screening colonoscopy for colon cancer, application of therapeutic colonoscopy, and exciting new technical improvements.
Collapse
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, Department of Medicine, State University of New York, Downstate Medical School, Brooklyn, NY, USA
| | | |
Collapse
|
25
|
Cappell MS, Friedel D. The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders. Med Clin North Am 2002; 86:1165-216. [PMID: 12510452 DOI: 10.1016/s0025-7125(02)00075-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Esophagogastroduodenoscopy has revolutionized the clinical management of upper gastrointestinal diseases. Millions of EGDs are performed annually in the United States for many indications, such as gastrointestinal bleeding, abdominal pain, dysphagia, or surveillance of premalignant lesions. Esophagogastroduodenoscopy is very safe, with a low risk of serious complications such as perforation, cardiopulmonary arrest, or aspiration pneumonia. It is a highly sensitive and specific diagnostic test, especially when combined with endoscopic biopsy. Esophagogastroduodenoscopy is increasingly being used therapeutically to avoid surgery. New endoscopic technology such as endosonography, endoscopic sewing, and the endoscopic videocapsule will undoubtedly extend the frontiers and increase the indications for endoscopy.
Collapse
Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, Department of Medicine, State University of New York, Downstate Medical School, Brooklyn, NY, USA
| | | |
Collapse
|
26
|
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
| | | |
Collapse
|
27
|
Wong WM, Cheung CC, Lau KW. A rare cause of gastrointestinal bleeding: Blue rubber bleb nevus syndrome. ACTA ACUST UNITED AC 2001. [DOI: 10.1046/j.1442-2034.2001.00076.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
28
|
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.
Collapse
Affiliation(s)
- D Ertem
- Marmara University School of Medicine, Division Pediatric Gastroenterology and Nutrition, Tophanelioglu Cd. 13-15, 81190 Altunizade-Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
29
|
Rodrigues D, Bourroul ML, Ferrer AP, Monteiro Neto H, Gonçalves ME, Cardoso SR. Blue rubber bleb nevus syndrome. REVISTA DO HOSPITAL DAS CLINICAS 2000; 55:29-34. [PMID: 10881076 DOI: 10.1590/s0041-87812000000100006] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The blue rubber nevus syndrome consists of multiple venous malformations in the skin and gastrointestinal tract associated with intestinal hemorrhage and iron deficiency anemia. Other organs may be involved. The causes of this syndrome are unknown. Its most common presentation is in the form of sporadic cases, but dominant autosomal inheritance has been described. It is a condition that affects both sexes equally, and its occurrence is rare in the black race. We present a case of this syndrome diagnosed in a 11-year-old patient. He had severe anemia and a venous swelling on the trunk. Similar lesions were found in the stomach, bowel, and on his foot. We emphasize the main clinical aspects: intestine, eyes, nasopharynx, parotids, lungs, liver, spleen, heart, brain, pleura, peritoneum, pericardium, skeletal muscles, bladder, and penis lesions, systemic complications that may occur to these patients which are thrombosis and calcification, as well as consumptive coagulopathy and thrombocytopenia that may occur within the nevi.
Collapse
Affiliation(s)
- D Rodrigues
- Children's Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
30
|
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.
Collapse
Affiliation(s)
- J S Goraya
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | |
Collapse
|
31
|
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
| | | | | | | | | | | | | |
Collapse
|
32
|
Esterly NB. Cutaneous hemangiomas, vascular stains and malformations, and associated syndromes. CURRENT PROBLEMS IN PEDIATRICS 1996; 26:3-39. [PMID: 8932511 DOI: 10.1016/s0045-9380(96)80023-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|