Clinical Challenges and Images in GI
2007; Elsevier BV; Volume: 132; Issue: 5 Linguagem: Inglês
10.1053/j.gastro.2007.03.081
ISSN1528-0012
AutoresJoram Wardi, Mark Shahmurov, Abraham Czerniak, Yona Avni,
Tópico(s)Gastrointestinal Tumor Research and Treatment
ResumoImage 2Question: A 77-year-old man suffered from iron deficiency anemia for 2 years and episodes of melena for the past 2 months. The rate of bleeding was slow and the patient required transfusions of 1 unit of packed red blood cells every second week. He had a past history of ischemic heart disease and coronary artery bypass surgery 12 years earlier and suffered from type 2 diabetes mellitus. Except for the iron deficiency anemia and decreases of the hemoglobin values down to 8 g/dL, all the laboratory values were in the normal range. The investigation of anemia included repeated colonoscopies, gastroscopy, small bowel follow through, and computed tomography of the abdomen, which all were normal. The patient was referred to capsule endoscopy that showed the following finding in the ileum (Figures A and B). What is the diagnosis?View Large Image Figure ViewerDownload Hi-res image Download (PPT)Look on page 2083 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.Answer to the Clinical Challenges and Images in GI Question: Image 2 (page 1656): Capillary Hemangioma of Small IntestineCapsule endoscopy (Given Imaging, Yoqneam, Israel) demonstrated a spontaneously bleeding nodule in the ileum. The patient was sent to surgery and a polypoid lesion of 1 cm was found in the ileum about 1 m proximal to the ileocecal valve. The lesion was resected, and histopathology showed a polypoid structure of small intestine (Figure C) composed of proliferating capillaries (Figure D) compatible with a capillary hemangioma. The patient recovered quickly and has had no gastrointestinal bleeding since the operation 1 year ago. The hemoglobin value increased to normal and is stable.View Large Image Figure ViewerDownload Hi-res image Download (PPT)The small bowel is the source of gastrointestinal bleeding in 2% to 10% of all bleeding episodes and the percentage is probably even higher in the subset of patients with obscure gastrointestinal bleeding.1Ell C. Remke S. May A. Helou L. Henrich R. Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.Endoscopy. 2002; 34: 685-689Crossref PubMed Scopus (666) Google Scholar Vascular tumors of the small bowel are very rare, accounting for 7% to 10% of all benign tumors of the small bowel. They are classified as capillary hemangiomas, cavernous hemangiomas, and hemangiomas associated with multisystem vascular disorders such as Klippel–Trenaunay, Rendu–Osler–Weber, Blue Rubber Bleb Nevus, and Maffucci’s syndromes.2Fenoglio-Preiser C.M. Gastrointestinal pathology: an atlas and text. 2nd ed. Lippincott-Raven, Philadelphia1999Google Scholar Capillary hemangiomas are usually solitary and may vary in size from nodules of few millimeters to large lesions up to 11 cm projecting into the bowel lumen. They consist of closely packed submucosal capillaries. The main presenting symptom of capillary hemangioma is bleeding, which tends to be slow and occult as in our patient. If bigger in size, it can cause intussusception and bowel obstruction. Cavernous hemangiomas arise from larger submucosal arteries and veins and therefore usually present with a more severe onset of hematemesis or melena.3Ruiz A.R. Ginsberg A.L. Giant mesenteric hemangioma with small intestinal involvement An unusual cause of recurrent gastrointestinal bleed and review of gastrointestinal hemangiomas.Dig Dis Sci. 1999; 44: 2545-2551Crossref PubMed Scopus (29) Google Scholar Video capsule endoscopy is superior to push enteroscopy or small bowel radiography for significant findings in the small bowel in patients with obscure gastrointestinal bleeding.4Triester S.L. Leighton J.A. Leontiadis G.L. Fleischer D.E. Hara A.K. Heigh R.I. Shiff A.D. Sharma V.K. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.Am J Gastroenterol. 2005; 100: 2407-2418Crossref PubMed Scopus (556) Google Scholar Image 2Question: A 77-year-old man suffered from iron deficiency anemia for 2 years and episodes of melena for the past 2 months. The rate of bleeding was slow and the patient required transfusions of 1 unit of packed red blood cells every second week. He had a past history of ischemic heart disease and coronary artery bypass surgery 12 years earlier and suffered from type 2 diabetes mellitus. Except for the iron deficiency anemia and decreases of the hemoglobin values down to 8 g/dL, all the laboratory values were in the normal range. The investigation of anemia included repeated colonoscopies, gastroscopy, small bowel follow through, and computed tomography of the abdomen, which all were normal. The patient was referred to capsule endoscopy that showed the following finding in the ileum (Figures A and B). What is the diagnosis?Look on page 2083 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Question: A 77-year-old man suffered from iron deficiency anemia for 2 years and episodes of melena for the past 2 months. The rate of bleeding was slow and the patient required transfusions of 1 unit of packed red blood cells every second week. He had a past history of ischemic heart disease and coronary artery bypass surgery 12 years earlier and suffered from type 2 diabetes mellitus. Except for the iron deficiency anemia and decreases of the hemoglobin values down to 8 g/dL, all the laboratory values were in the normal range. The investigation of anemia included repeated colonoscopies, gastroscopy, small bowel follow through, and computed tomography of the abdomen, which all were normal. The patient was referred to capsule endoscopy that showed the following finding in the ileum (Figures A and B). What is the diagnosis? Look on page 2083 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Answer to the Clinical Challenges and Images in GI Question: Image 2 (page 1656): Capillary Hemangioma of Small IntestineCapsule endoscopy (Given Imaging, Yoqneam, Israel) demonstrated a spontaneously bleeding nodule in the ileum. The patient was sent to surgery and a polypoid lesion of 1 cm was found in the ileum about 1 m proximal to the ileocecal valve. The lesion was resected, and histopathology showed a polypoid structure of small intestine (Figure C) composed of proliferating capillaries (Figure D) compatible with a capillary hemangioma. The patient recovered quickly and has had no gastrointestinal bleeding since the operation 1 year ago. The hemoglobin value increased to normal and is stable.The small bowel is the source of gastrointestinal bleeding in 2% to 10% of all bleeding episodes and the percentage is probably even higher in the subset of patients with obscure gastrointestinal bleeding.1Ell C. Remke S. May A. Helou L. Henrich R. Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.Endoscopy. 2002; 34: 685-689Crossref PubMed Scopus (666) Google Scholar Vascular tumors of the small bowel are very rare, accounting for 7% to 10% of all benign tumors of the small bowel. They are classified as capillary hemangiomas, cavernous hemangiomas, and hemangiomas associated with multisystem vascular disorders such as Klippel–Trenaunay, Rendu–Osler–Weber, Blue Rubber Bleb Nevus, and Maffucci’s syndromes.2Fenoglio-Preiser C.M. Gastrointestinal pathology: an atlas and text. 2nd ed. Lippincott-Raven, Philadelphia1999Google Scholar Capillary hemangiomas are usually solitary and may vary in size from nodules of few millimeters to large lesions up to 11 cm projecting into the bowel lumen. They consist of closely packed submucosal capillaries. The main presenting symptom of capillary hemangioma is bleeding, which tends to be slow and occult as in our patient. If bigger in size, it can cause intussusception and bowel obstruction. Cavernous hemangiomas arise from larger submucosal arteries and veins and therefore usually present with a more severe onset of hematemesis or melena.3Ruiz A.R. Ginsberg A.L. Giant mesenteric hemangioma with small intestinal involvement An unusual cause of recurrent gastrointestinal bleed and review of gastrointestinal hemangiomas.Dig Dis Sci. 1999; 44: 2545-2551Crossref PubMed Scopus (29) Google Scholar Video capsule endoscopy is superior to push enteroscopy or small bowel radiography for significant findings in the small bowel in patients with obscure gastrointestinal bleeding.4Triester S.L. Leighton J.A. Leontiadis G.L. Fleischer D.E. Hara A.K. Heigh R.I. Shiff A.D. Sharma V.K. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.Am J Gastroenterol. 2005; 100: 2407-2418Crossref PubMed Scopus (556) Google Scholar Capsule endoscopy (Given Imaging, Yoqneam, Israel) demonstrated a spontaneously bleeding nodule in the ileum. The patient was sent to surgery and a polypoid lesion of 1 cm was found in the ileum about 1 m proximal to the ileocecal valve. The lesion was resected, and histopathology showed a polypoid structure of small intestine (Figure C) composed of proliferating capillaries (Figure D) compatible with a capillary hemangioma. The patient recovered quickly and has had no gastrointestinal bleeding since the operation 1 year ago. The hemoglobin value increased to normal and is stable. The small bowel is the source of gastrointestinal bleeding in 2% to 10% of all bleeding episodes and the percentage is probably even higher in the subset of patients with obscure gastrointestinal bleeding.1Ell C. Remke S. May A. Helou L. Henrich R. Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.Endoscopy. 2002; 34: 685-689Crossref PubMed Scopus (666) Google Scholar Vascular tumors of the small bowel are very rare, accounting for 7% to 10% of all benign tumors of the small bowel. They are classified as capillary hemangiomas, cavernous hemangiomas, and hemangiomas associated with multisystem vascular disorders such as Klippel–Trenaunay, Rendu–Osler–Weber, Blue Rubber Bleb Nevus, and Maffucci’s syndromes.2Fenoglio-Preiser C.M. Gastrointestinal pathology: an atlas and text. 2nd ed. Lippincott-Raven, Philadelphia1999Google Scholar Capillary hemangiomas are usually solitary and may vary in size from nodules of few millimeters to large lesions up to 11 cm projecting into the bowel lumen. They consist of closely packed submucosal capillaries. The main presenting symptom of capillary hemangioma is bleeding, which tends to be slow and occult as in our patient. If bigger in size, it can cause intussusception and bowel obstruction. Cavernous hemangiomas arise from larger submucosal arteries and veins and therefore usually present with a more severe onset of hematemesis or melena.3Ruiz A.R. Ginsberg A.L. Giant mesenteric hemangioma with small intestinal involvement An unusual cause of recurrent gastrointestinal bleed and review of gastrointestinal hemangiomas.Dig Dis Sci. 1999; 44: 2545-2551Crossref PubMed Scopus (29) Google Scholar Video capsule endoscopy is superior to push enteroscopy or small bowel radiography for significant findings in the small bowel in patients with obscure gastrointestinal bleeding.4Triester S.L. Leighton J.A. Leontiadis G.L. Fleischer D.E. Hara A.K. Heigh R.I. Shiff A.D. Sharma V.K. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.Am J Gastroenterol. 2005; 100: 2407-2418Crossref PubMed Scopus (556) Google Scholar
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