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Dukmak ON, Ayyad M, Gabajah M, Dabbas F, Budair A, Emar M, Maraqa M, Joubran F. Duodenal Hemangioma as a Rare Cause of Gastrointestinal Bleeding: A Case Report and Literature Review. Cureus 2023; 15:e43293. [PMID: 37692602 PMCID: PMC10492641 DOI: 10.7759/cureus.43293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Duodenal hemangiomas are benign vascular tumors caused by haphazard vascular proliferation within the duodenal wall. Although rare, duodenal hemangiomas could lead to rapidly progressive life-threatening gastrointestinal (GI) bleeding that requires urgent intervention. The diagnosis of duodenal hemangioma often requires direct visualization of the lesion either endoscopically or surgically, as well as histopathological examination. Treatment options include endoscopic resection, laser coagulation, sclerotherapy, or in a specific subset of patients, open or laparoscopic surgical intervention. We herein report a case of a 46-year-old female presenting with signs and symptoms of chronic GI bleeding. The patient underwent upper endoscopy and was found to have an ulcerated mass in the proximal duodenum consistent with the diagnosis of duodenal hemangioma. This case highlights the importance of including duodenal hemangioma in the differential of upper GI bleeding. It also underscores the significance of surgical intervention in treating duodenal hemangioma, as well as the crucial role of employing endoscopy in the diagnostic and therapeutic management of this condition.
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Shim J, Kim ES. Small Bowel Hemangioma Complicated with Obstruction. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022. [DOI: 10.4166/kjg.2022.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jeongyun Shim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Duanmu J, Liang Y, Huang Z, Tan Y, Li T, Lei X. Cavernous haemangioma of the duodenum with acute massive bleeding in the ascending portion: a case report. J Int Med Res 2021; 49:3000605211010091. [PMID: 34590919 PMCID: PMC8489767 DOI: 10.1177/03000605211010091] [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] [Indexed: 12/04/2022] Open
Abstract
Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120–175 g/l). Albumin level was also low at 28 g/l (normal range, 40–55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.
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Affiliation(s)
- Jinzhong Duanmu
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yahang Liang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhixiang Huang
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yongming Tan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Taiyuan Li
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Gastrointestinal Surgery Institute, Nanchang University, Nanchang, Jiangxi, China
| | - Xiong Lei
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Gastrointestinal Surgery Institute, Nanchang University, Nanchang, Jiangxi, China
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Vedaei SS, Wahid KA. A localization method for wireless capsule endoscopy using side wall cameras and IMU sensor. Sci Rep 2021; 11:11204. [PMID: 34045554 PMCID: PMC8160358 DOI: 10.1038/s41598-021-90523-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/11/2021] [Indexed: 02/08/2023] Open
Abstract
Localizing the endoscopy capsule inside gastrointestinal (GI) system provides key information which leads to GI abnormality tracking and precision medical delivery. In this paper, we have proposed a new method to localize the capsule inside human GI track. We propose to equip the capsule with four side wall cameras and an Inertial Measurement Unit (IMU), that consists of 9 Degree-Of-Freedom (DOF) including a gyroscope, an accelerometer and a magnetometer to monitor the capsule’s orientation and direction of travel. The low resolution mono-chromatic cameras, installed along the wide wall, are responsible to measure the actual capsule movement, not the involuntary motion of the small intestine. Finally, a fusion algorithm is used to combine all data to derive the traveled path and plot the trajectory. Compared to other methods, the presented system is resistive to surrounding conditions, such as GI nonhomogeneous structure and involuntary small bowel movements. In addition, it does not require external antenna or arrays. Therefore, GI tracking can be achieved without disturbing patients’ daily activities.
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Affiliation(s)
- Seyed Shahim Vedaei
- Department of Electrical and Computer Engineering, University of Saskatchewan, Saskatoon, SK, S7N 5A9, Canada.
| | - Khan A Wahid
- Department of Electrical and Computer Engineering, University of Saskatchewan, Saskatoon, SK, S7N 5A9, Canada
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Al-Tkrit A, Aneeb M, Mekaiel A, Alawawdeh F, Mehta A. Cavernous Hemangioma: A Rare Cause of Massive Lower Gastrointestinal Bleeding. Cureus 2020; 12:e10075. [PMID: 32999791 PMCID: PMC7522049 DOI: 10.7759/cureus.10075] [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] [Indexed: 01/19/2023] Open
Abstract
Due to their rarity, intestinal hemangiomas are not commonly considered as a cause of gastrointestinal (GI) bleeding. This report describes a patient who presented with massive, recurrent lower GI bleeding secondary to a cavernous hemangioma of the small intestine. The source of GI bleeding could not initially be identified despite using numerous diagnostic modalities. The lesion was eventually revealed on diagnostic laparoscopy and small bowel resection was performed.
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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.
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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
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Alventosa Mateu C, Sempere García-Argüelles J, Luján Sanchis M, Pou Santonja G. Cavernous haemangioma of the jejunum: An uncommon cause of iron deficiency anaemia. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:327-328. [PMID: 32245596 DOI: 10.1016/j.gastrohep.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/25/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Carlos Alventosa Mateu
- Servicio de Patología Digestiva, Hospital Vithas Valencia 9 de Octubre, Valencia, España.
| | | | - Marisol Luján Sanchis
- Servicio de Patología Digestiva, Hospital Vithas Valencia Consuelo, Valencia, España
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Numan L, Elkafrawy A, Brotherton T, Tomaw A, Campbell D. Jejunal Submucosal Hemangioma as a Cause of Massive Gastrointestinal Bleeding: A Case Report. Cureus 2020; 12:e8372. [PMID: 32626616 PMCID: PMC7328703 DOI: 10.7759/cureus.8372] [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: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 12/05/2022] Open
Abstract
Small intestinal hemangiomas are uncommon tumors that frequently present with gastrointestinal bleeding (GIB). Diagnosis, detection, and treatment can be challenging and may require surgical intervention. An 81-year-old female presented with melena. Video capsule endoscopy revealed active bleeding in the proximal jejunum and push enteroscopy identified a polypoid nodule with central umbilication. The patient underwent laparoscopic resection and jejunal submucosal hemangioma was detected. Submucosal hemangiomas are a rare cause of GIB. As the most common site of submucosal hemangiomas is the mid-jejunum, they are not easy to detect. Surgical intervention is usually required for a definitive diagnosis and definitive treatment.
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Affiliation(s)
- Laith Numan
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Ahmed Elkafrawy
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Tim Brotherton
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Andrew Tomaw
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Donald Campbell
- Gastroenterology, University of Missouri Kansas City and Saint Luke's Hospital, Kansas City, USA
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Fu JX, Zou YN, Han ZH, Yu H, Wang XJ. Small bowel racemose hemangioma complicated with obstruction and chronic anemia: A case report and review of literature. World J Gastroenterol 2020; 26:1674-1682. [PMID: 32327915 PMCID: PMC7167414 DOI: 10.3748/wjg.v26.i14.1674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal hemangiomas are rare benign tumors. According to the size of the affected vessels, hemangiomas are histologically classified into cavernous, capillary, or mixed-type tumors, with the cavernous type being the most common and racemose hemangiomas being very rare in the clinic. Melena of uncertain origin and anemia are the main clinical manifestations, and other presentations are rare. Due to the rarity of gastrointestinal hemangiomas and lack of specific manifestations and diagnostic methods, preoperative diagnoses are often delayed or incorrect.
CASE SUMMARY We report a 5-year-old girl who presented with abdominal pain, nausea, and vomiting for a duration of 10 h. The laboratory studies showed prominent anemia. Computed tomography and contrast-enhanced computed tomography of the abdomen revealed a small bowel obstruction caused by a giant abdominal mass. Segmental resection of the ileal lesions was performed through surgery, and the final pathology results revealed a diagnosis of racemose hemangioma complicated by a small bowel obstruction and simultaneous chronic anemia.
CONCLUSION The current report will increase the understanding of the diagnosis and treatment of gastrointestinal hemangiomas and provide a review of the related literature.
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Affiliation(s)
- Ji-Xin Fu
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Ya-Nan Zou
- Department of Anesthesiology, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Zhi-Hao Han
- Department of Radiology, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Hao Yu
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai 264200, Shandong Province, China
| | - Xin-Jian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai 264200, Shandong Province, China
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Grgić D, Prijić R, Romić I, Augustin G, Markoš P, Korša L, Marušić Z, Rustemović N, Krznarić Ž. A Single Small Bowel Hemangioma Detected by Video Capsule Endoscopy in a Patient Presenting with Iron-deficiency Anemia - Two Case Reports. Prague Med Rep 2020; 120:138-143. [PMID: 31935349 DOI: 10.14712/23362936.2019.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hemangioma of the small intestine is a rare vascular malformation which mostly presents as occult gastrointestinal bleeding and iron-deficiency anemia. Patients are often asymptomatic except of fatigue due to anemia. Hemangiomas can arise anywhere in the luminal gastrointestinal tract, with jejunum as the most commonly involved site. They are very hard to recognize mostly due to their localization. Video capsule endoscopy and balloon-assisted enteroscopy have very much improved preoperative diagnostics and made major contribution to establishing the diagnosis - which was very difficult in the past and almost all cases were diagnosed during or after the operation. Surgical resection is still the conventional treatment modality, although with the improvement of endoscopic therapeutic interventions (endoscopic mucosal resection, argon-plasma coagulation) there are more therapeutic possibilities.
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Affiliation(s)
- Dora Grgić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Radovan Prijić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ivan Romić
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pave Markoš
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lea Korša
- Deparment of Pathology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zlatko Marušić
- Deparment of Pathology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nadan Rustemović
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Željko Krznarić
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Management of small bowel polyps: from small to big. Curr Opin Gastroenterol 2019; 35:250-256. [PMID: 30844897 DOI: 10.1097/mog.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Benign small bowel polyps or mass are clinically poorly distinguishable from malignant small bowel masses, and the diagnostic conditions are almost the same. The important point for clinicians is first to take advantage of the different available diagnostic tools to optimize the diagnostic algorithm of a small bowel polyp or mass. Next, according to the clinical situation, associated disease or sporadic situation, the difficulty is to adapt the treatment decision to the patient situation. RECENT FINDINGS The last 20 years have been marked by the development of major diagnostic tools for small bowel diseases (capsule endoscopy, cross-sectional imaging with enteroclysis and balloon-assisted enteroscopy) and by the major decrease of intra-operative enteroscopy as a diagnostic mean. SUMMARY On the basis of considerable development of capsule endoscopy and the improvement of cross-sectional small bowel imagining, small bowel polyps represent now a frequent clinical situation for gastroenterologists.
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Hu PF, Chen H, Wang XH, Wang WJ, Su N, Shi B. Small intestinal hemangioma: Endoscopic or surgical intervention? A case report and review of literature. World J Gastrointest Oncol 2018; 10:516-521. [PMID: 30595805 PMCID: PMC6304305 DOI: 10.4251/wjgo.v10.i12.516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemangioma of the small intestine is a rare vascular malformation. Before the advent of capsule endoscopy (CE) and balloon-assisted enteroscopy (BAE), preoperative diagnosis of this disease was extremely difficult.
CASE SUMMARY In this study, we report a 24-year-old female with a large transmural small bowel cavernous hemangioma, which was diagnosed with CE and BAE preoperatively and removed successfully using minimally invasive surgery. Meanwhile, we perform a literature review of the studies about intestinal hemangiomas published after 2000. Literature review revealed that 91.9% of the lesions were diagnosed preoperatively by CE and/or BAE and 45.9% of them were treated endoscopically, which is a marked improvement compared to before 2000. Therefore, CE and BAE are useful modalities for the preoperative diagnosis of hemangiomas in the small intestine.
CONCLUSION Endoscopic treatment of intestinal hemangioma is generally prudent and might be suitable for multiple, relatively small lesions.
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Affiliation(s)
- Ping-Fang Hu
- Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Han Chen
- Department of General Surgery, Hongkou Branch of Changhai Hospital, Second Military Medical University, Shanghai 200081, China
| | - Xiao-Hang Wang
- Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Wei-Jun Wang
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Ning Su
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Bin Shi
- Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Abstract
PURPOSE OF REVIEW The objective is to provide an overview on the cause of small bowel bleeding. We discuss the role of small bowel endoscopy in the management of small bowel bleeding and provide an outline of pharmacotherapy that can be additionally beneficial. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is the initial diagnostic investigation of choice in small bowel bleeding. Computed tomography (CT) can be helpful in the context of small bowel tumours. Device-assisted enteroscopy (DAE) enables several therapeutic procedures such as argon plasma coagulation (APC) and haemoclip application. It can also guide further management with histology or by marking culprit lesions with India ink. A persistent rate of rebleeding despite APC is increasingly being reported. Pharmacotherapy has an emerging role in the management of small bowel bleeding. Somatostatin analogues are a well tolerated class of drugs that can play an additional role in the management of refractory bleeding secondary to small bowel angioectasias. SUMMARY SBCE is useful in determining the cause of small bowel bleeding. DAE offers an endoscopic therapeutic approach to small bowel bleeding replacing surgery and intraoperative enteroscopy. Pharmacotherapy, in addition to endotherapy, can play an important role in the management of multifocal, recurring bleeding small bowel lesions.
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