Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Capillary Hemangioma in the Jejunum Detected by Single Balloon Enteroscopy in a Patient with Anemia

빈혈 환자에서 단일풍선 소장내시경으로 발견한 공장의 모세혈관상 혈관종 1예

  • Cho, Jun-Hyung (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Jang, Jae-Young (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Cho, Chang-Hyun (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Shim, Jae-Jun (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Dong, Seok-Ho (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Kim, Hyo-Jong (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Kim, Byung-Ho (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Chang, Young-Woon (Department of Internal Medicine, Kyunghee University College of Medicine)
  • 조준형 (경희대학교 의과대학 내과학교실) ;
  • 장재영 (경희대학교 의과대학 내과학교실) ;
  • 조창현 (경희대학교 의과대학 내과학교실) ;
  • 심재준 (경희대학교 의과대학 내과학교실) ;
  • 동석호 (경희대학교 의과대학 내과학교실) ;
  • 김효종 (경희대학교 의과대학 내과학교실) ;
  • 김병호 (경희대학교 의과대학 내과학교실) ;
  • 장영운 (경희대학교 의과대학 내과학교실)
  • Published : 2011.04.30
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Abstract

Hemangiomas are uncommon benign vascular tumors that account for up to 10% of all small bowel tumors. The jejunum is the most common location, and gastrointestinal bleeding is a frequent clinical presentation. Histologically, hemangiomas are classified as cavernous, capillary, or mixed types. Capillary hemangiomas are dense collections of capillaries usually with a hyperplastic endothelium. There have been a few cases of small bowel capillary hemangioma revealed by capsule endoscopy and confirmed after surgical resection. But preoperative detection of hemangiomas in the small intestine has not been reported, as far as we know, associated with the use of balloon-assisted enteroscopy. This report describes a 44-year-old male with a small bowel mass considered to be a cause of severe iron deficiency anemia. In this case, we performed capsule endoscopy and single balloon enteroscopy to examine the lesion. The patient then underwent a segmental resection of the jejunum, which confirmed the presence of a capillary hemangioma with surface ulceration.

소장 혈관종은 매우 드문 질환이며 관련 증상으로 위장관 출혈이 대표적이다. 공장이 가장 호발하는 부위로 진단을 위해서는 캡슐내시경이나 소장내시경을 이용한 소장 관찰이 필요하다. 모세혈관상 혈관종은 작은 모세혈관의 내피 세포가 과다증식하여 발생하는 비상피성 양성 종양으로, 이번 증례와 같이 소장의 모세혈관상 혈관종을 수술 전에 단일풍선 소장내시경으로 발견한 보고는 없다. 저자들은 심한 빈혈로 내원한 환자에서 캡슐내시경과 단일풍선 소장내시경을 시행하고 소장 분절 절제술로 치료한 모세혈관상 혈관종 1예를 경험하여서 문헌고찰과 함께 보고한다.

Keywords

References

  1. Rochlin DB, Longmire WP Jr. Primary tumors of the small intestine. Surgery 1961;50:586-592.
  2. Levy AD, Abbott RM, Rohrmann CA Jr, Frazier AA, Kende A. Gastrointestinal hemangiomas: imaging findings with pathologic correlation in pediatric and adult patients. AJR Am J Roentgenol 2001;177:1073-1081. https://doi.org/10.2214/ajr.177.5.1771073
  3. Gordon FH, Watkinson A, Hodgson H. Vascular malformations of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2001;15:41-58. https://doi.org/10.1053/bega.2000.0155
  4. de Mascarenhas-Saraiva MN, da Silva Araujo Lopes LM. Small-bowel tumors diagnosed by wireless capsule endoscopy: report of five cases. Endoscopy 2003;35:865-868. https://doi.org/10.1055/s-2003-42625
  5. Kim YS, Chun HJ, Jeen YT, Um SH, Kim CD, Hyun JH. Small bowel capillary hemangioma. Gastrointest Endosc 2004;60:599. https://doi.org/10.1016/S0016-5107(04)01859-0
  6. Wardi J, Shahmurov M, Czerniak A, Avni Y. Clinical challenges and images in GI. Capillary hemangioma of small intestine. Gastroenterology 2007;132:1656. https://doi.org/10.1053/j.gastro.2007.03.081
  7. Ludwig E, Kurtz RC. Tumors of the small intestine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Volume 2. 9th ed. Philadelphia: Saunders Elsevier, 2010:2145-2153.
  8. Wilson JM, Melvin DB, Gray G, Thorbjarnarson B. Benign small bowel tumor. Ann Surg 1975;181:247-250.
  9. Cheung DY, Lee IS, Chang DK, et al. Capsule endoscopy in small bowel tumors: a multicenter Korean study. J Gastroenterol Hepatol 2010;25:1079-1086. https://doi.org/10.1111/j.1440-1746.2010.06292.x
  10. Ruiz AR Jr, Ginsberg AL. Giant mesenteric hemangioma with small intestinal involvement: an unusual cause of recurrent gastrointestinal bleed and review of gastrointestinal hemangiomas. Dig Dis Sci 1999;44:2545-2551. https://doi.org/10.1023/A:1026659710815
  11. Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol 1980;4:470-479.
  12. Bank ER, Hernandez RJ, Byrne WJ. Gastrointestinal hemangiomatosis in children: demonstration with CT. Radiology 1987;165:657-658. https://doi.org/10.1148/radiology.165.3.3500485
  13. Lee NK, Kim S, Kim GH, et al. Hypervascular subepithelial gastrointestinal masses: CT-pathologic correlation. Radiographics 2010;30:1915-1934. https://doi.org/10.1148/rg.307105028
  14. Ohmiya N, Taguchi A, Shirai K, et al. Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at doubleballoon enteroscopy without laparotomy. Gastrointest Endosc 2005;61:140-147. https://doi.org/10.1016/S0016-5107(04)02457-5
  15. Bak YT, Oh CH, Kim JH, Lee CH. Blue rubber bleb nevus syndrome: endoscopic removal of the gastrointestinal hemangiomas. Gastrointest Endosc 1997;45:90-92. https://doi.org/10.1016/S0016-5107(97)70311-0
  16. Liang LC, Forbes N, David J, Ozick L. Endoscopic polypectomy of an unusually long polypoid colorectal cavernous hemangioma. Gastrointest Endosc 1998;47:307-308. https://doi.org/10.1016/S0016-5107(98)70334-7
  17. Willert RP, Chong AK. Multiple cavernous hemangiomas with iron deficiency anemia successfully treated with doubleballoon enteroscopy. Gastrointest Endosc 2008;67:765-767. https://doi.org/10.1016/j.gie.2007.07.044
  18. Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2008; 22:313-328. https://doi.org/10.1016/j.bpg.2007.10.026
  19. Pohl J, Blancas JM, Cave D, et al. Consensus report of the 2nd international conference on double balloon enteroscopy. Endoscopy 2008;40:156-160. https://doi.org/10.1055/s-2007-966994