Endoscopy 2007; 39: E319
DOI: 10.1055/s-2007-966799
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Vascular malformation of the small intestine

Z.  Liao1 , R.  Gao1 , Z.-S.  Li1
  • 1Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
Further Information

Z.-S. Li, MD

Department of Gastroenterology

Digestive Endoscopy Center

Changhai Hospital

The Second Military Medical University

174 Changhai Road

Shanghai 200433

China

Fax: +86-21-55621735

Email: zhaoshenli@hotmail.com

Publication History

Publication Date:
08 January 2008 (online)

Table of Contents

    A 38-year-old Chinese man presented to our hospital with a 2-week history of dizziness and of passing black stools. Laboratory test results included the following (with normal ranges in parentheses): hemoglobin 4.9 g/dL (12 - 16 g/dL), red blood cell count 1.76 × 1012/L (4.0 - 5.5 × 1012/L), white cell count 8.01 × 109/L (4.0 - 10.0 × 109/L), platelet count 333 × 109/L (100 - 300 × 109/L). Biochemical parameters, including electrolytes and liver and renal function tests were within normal limits. Stool examination was positive for occult blood, but upper gastrointestinal endoscopy and colonoscopy examinations were both negative. The patient was transfused with 3 units of packed red blood cells. Capsule endoscopy (OMOM; Chongqing Jinshan Science & Technology Inc., China) was performed in order to further evaluate the patient’s occult gastrointestinal tract bleeding and this showed a polypoid lesion with a surface ulcer in the small bowel ([Fig. 1]). Double-balloon enteroscopy confirmed this finding in the jejunum, 70 cm distal (anal) to the ligament of Treitz ([Fig. 2]).

    Zoom Image

    Fig. 1 Capsule endoscopy revealed a polypoid lesion in the small bowel, with surface ulceration.

    Zoom Image

    Fig. 2 Double-balloon enteroscopy showed a polypoid lesion with a surface ulcer in the jejunum, 70 cm distal (anal) to the ligament of Treitz.

    The patient underwent a jejunal resection and the surgical specimen showed a polypoid lesion measuring 0.8 cm × 0.8 cm. Histologic examination revealed surface mucosal necrosis and the presence of enlarged, twisted, thick-walled blood vessels with local rupture and thrombosis in the submucosa, surrounded by an inflammatory infiltrate ([Fig. 3]). The diagnosis of vascular malformation was suggested. There has been no recurrence of gastrointestinal bleeding 4 months after the jejunal resection.

    Zoom Image

    Fig. 3 Histologic examination revealed surface mucosal necrosis and enlarged, twisted, thick-walled blood vessels in the submucosa (hematoxylin and eosin stain, original magnification × 40).

    This type of vascular lesion can cause occult gastrointestinal bleeding. Capsule endoscopy and double-balloon enteroscopy are useful in the diagnosis of such lesions, and surgical resection is regarded as a curative treatment. Perhaps, in the future, this type of vascular lesion will be removed by interventional double-balloon enteroscopy.

    Endoscopy_UCTN_Code_CCL_1AC_2AB

    Endoscopy_UCTN_Code_CCL_1AC_2AC

    Z.-S. Li, MD

    Department of Gastroenterology

    Digestive Endoscopy Center

    Changhai Hospital

    The Second Military Medical University

    174 Changhai Road

    Shanghai 200433

    China

    Fax: +86-21-55621735

    Email: zhaoshenli@hotmail.com

    Z.-S. Li, MD

    Department of Gastroenterology

    Digestive Endoscopy Center

    Changhai Hospital

    The Second Military Medical University

    174 Changhai Road

    Shanghai 200433

    China

    Fax: +86-21-55621735

    Email: zhaoshenli@hotmail.com

    Zoom Image

    Fig. 1 Capsule endoscopy revealed a polypoid lesion in the small bowel, with surface ulceration.

    Zoom Image

    Fig. 2 Double-balloon enteroscopy showed a polypoid lesion with a surface ulcer in the jejunum, 70 cm distal (anal) to the ligament of Treitz.

    Zoom Image

    Fig. 3 Histologic examination revealed surface mucosal necrosis and enlarged, twisted, thick-walled blood vessels in the submucosa (hematoxylin and eosin stain, original magnification × 40).