Jejunal lymphangioma: rare case of GI bleeding

Soontornmanokul, Tanassanee; Angsuwatcharakorn, Phonthep; Viriyautsahakul, Vichai; Rerknimitr, Rungsun; Pantongrag-Brown, Linda; Wisedopas, Naruemon

doi:10.1016/j.gie.2012.06.001

Cited by 3 publications

(4 citation statements)

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“…From literature search, this is a rare case of jejunal lymphangioma diagnosed by push enteroscopy/endoscopy. There are several prior reports of jejunal lymphangioma mostly diagnosed by double-balloon enteroscopy and Sonde endoscopy [1][2][3]. Our case highlights the role of push enteroscopy/endoscopy for the diagnosis of proximal jejunal lesions that can lead to significant small-bowel bleeding, protein-losing enteropathy and intussusception.…”

Section: Discussionmentioning

confidence: 70%

Obscure Cause of Upper Gastrointestinal Hemorrhage

Koch¹

2020

GMR

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A 31year-old man presented to an outside institution's emergency department with headache, vomiting and no signs of bleeding. With decreased hemoglobin (hgb) of 4.6g/dl and normal head computerized tomography (CT), he was discharged on iron supplement. He presented to our emergency department 3 weeks later with weakness, tachycardia, hypotension, hgb of 5g/dl and a positive fecal occult blood test. With a normal colonoscopy and CT enterography, the patient was discharged to receive biweekly transfusions, and later underwent an outpatient small bowel capsule. Two months later the patient presented with weakness with no overt signs of bleeding and hgb was 4.2g/dl. Push enteroscopy identified a nearly circumferential mass in the proximal jejunum with stigmata of recent hemorrhage. Subsequently six months from the initial presentation, the patient underwent laparoscopic small bowel resection of a 7.3cm friable mass. The histopathology confirmed the endoscopic biopsy findings of a benign lymph vascular proliferation, favoring lymphangioma and an adjacent mesenteric lymph node with marked sinusoidal lymphangiectasia. One week post-surgery, the patient reported feeling well with an increased hgb of 7.1g/dl.

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Section: Discussionmentioning

confidence: 70%

Obscure Cause of Upper Gastrointestinal Hemorrhage

Koch¹

2020

GMR

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“…These lymphatic lesions grow from a primordial sac which fails to connect with the rest of the lymphatic system during the embryonic development, and which tends to grow due to muscle contractions and increase intramural pressure. Intramural lymphatic obstruction, endothelial permeability damage, swelling, and congenital absence on lymph have been suggested as other possible causes for the development of intestinal lymphangiomas [6]. …”

Section: Discussionmentioning

confidence: 99%

“…Most of the intestinal HLs are incidental findings, during an endoscopy or a radiological study [3–6]. …”

Section: Discussionmentioning

confidence: 99%

Duodenal hemangiolymphangioma presenting as chronic anemia: a case report

et al. 2016

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BackgroundLymphangiomas are a heterogeneous group of congenital vascular malformations characterized by cystic dilation of lymphatic vessels. They can occur at any age, but they are more common during childhood and in cutaneous localizations. Hemangiomas and vascular malformations of the gastrointestinal tract are very uncommon. Most are asymptomatic and diagnosis is often made as an incidental finding during endoscopy. On rare occasions the initial manifestation can be chronic anemia due to low grade gastrointestinal bleeding. They constitute an unusual manifestation and there is a low incidence of this type of tumor.Case presentationWe report the case of a 43 year-old latin female, with a 2-year history of chronic anemia requiring blood transfusion. Hemoglobin and Hematocrit count were low, therefore further studies were required to rule out bleeding sources or other causes of anemia. Enteroscopy findings showed a 35 mm lesion taking up 50 % of the circumference in the distal duodenum, with raised whitish edges secondary to confluent lymphangiectasia, a center with a vascular appearance and active bleeding spots. Biopsy samples dyed with India ink confirmed the diagnosis of hemangiolymphangioma.ConclusionDiagnostic difficulties in this case, highlight the need to include hemangiolymphangioma in the differential diagnosis of chronic anemia as well as the need for multiple diagnostic methods to confirm the presence of the condition.

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“…1 Intramural lymphatic obstruction, endothelial permeability damage, swelling, and congenital absence of lymph have been proposed as other possible causes for the development of small bowel lymphangiomas. 2 HLs are nodular lesion with cystic walls lying inside dilated lymphatic spaces and attenuated by endothelial cells. The cyst fluid can be chylous, hemorrhagic, or serous contained within a collagen stroma and abundant eosinophilic granules.…”

Section: Introductionmentioning

confidence: 99%

Diffuse hemangiolymphangioma of small bowel-rare cause of obscure gastrointestinal bleeding

et al. 2022

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Hemangiolymphangioma (HL) is a rare benign tumor, commonly present in pediatric age group that involves the head and neck. Small bowel HL has been reported as solitary or segmental involvement. Here we report a case of diffuse small bowel HL, presented as chronic anemia, fatigability and obscure gastrointestinal (GI) bleeding. A 42-year male presented with 15 years history of bleeding per rectum, anemia, and fatigability, received multiple blood transfusions. The exact cause could not be identified. His complete hemogram parameters were low requiring further imaging studies. Imaging and intraoperative enteroscopy showed multiple nodular lesions in mesentry as well as in the mucosa of the entire small bowel. Bleeding points were noted in a proximal jejunal lesion which was resected. Histopathological study confirmed as benign HL. HL are rare tumors of gastrointestinal tract. To the best of our knowledge diffuse HL of the small bowel have not been reported in the medical literature. With this case scenario, one should consider these tumors in the differential diagnosis of obscure lower GI bleed and chronic anemia, as well as explore definitive management options for these benign symptomatic tumors.

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Jejunal lymphangioma: rare case of GI bleeding

Cited by 3 publications

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Obscure Cause of Upper Gastrointestinal Hemorrhage

Obscure Cause of Upper Gastrointestinal Hemorrhage

Duodenal hemangiolymphangioma presenting as chronic anemia: a case report

Diffuse hemangiolymphangioma of small bowel-rare cause of obscure gastrointestinal bleeding

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