1
|
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.
Collapse
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
| |
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
|
Abstract
Vascular anomalies represent a diverse group of tumors and malformations. Those involving the colon and rectum can greatly impact patients' quality of life. Proper workup to ensure the correct diagnosis can vary and may include endoscopic and radiographic studies. These lesions can also be challenging to treat and often require a multidisciplinary approach to ensure the best possible outcome. Treatment can include medical therapy, sclerotherapy, endoscopic, and operative intervention. Many patients will require multimodal therapy. We discuss the workup and management of vascular lesions of the colon and rectum.
Collapse
Affiliation(s)
- Anna McGuire
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Belinda H Dickie
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, Massachusetts, United States
| |
Collapse
|
4
|
Evert K, Kühnel T, Weiß KT, Wohlgemuth WA, Vielsmeier V. [Diagnosis and management of vascular malformations : Interdisciplinary teamwork in demand]. DER PATHOLOGE 2019; 40:422-430. [PMID: 31243549 DOI: 10.1007/s00292-019-0625-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vascular anomalies are very rare, but can occur in children and adults in almost every region of the body. Due to the complexity of this disease, the path to a definitive diagnosis is often difficult. It requires interdisciplinary teamwork with close exchange of information between the individual treatment partners to reach the correct diagnosis and then to start the best therapy. This article provides an overview of the main types of vascular malformations from a clinical, imaging, and histological point of view, following the current classification of the International Society for the Study of Vascular Anomalies (ISSVA).
Collapse
Affiliation(s)
- K Evert
- Institut für Pathologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland.
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland.
| | - T Kühnel
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K T Weiß
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - W A Wohlgemuth
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland
- Department für Strahlenmedizin, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - V Vielsmeier
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|