An Unusual Colonic Lesion Associated with Chronic Gastrointestinal Bleeding

Abstract

A 71-year-old woman suffering from mild anemia with an hemoglobin level of 10.7 g/dL (normal ≥ 12 g/dL) was referred to our unit for further endoscopic evaluation. Upper gastrointestinal endoscopy revealed no abnormal findings. Colonoscopy detected a smoothly lined, thin and worm-like polyp measuring 6 cm in length with minor erosions on its surface. It was located in the left transverse colon. Microscopic examination of the resected specimen disclosed the very rare case of a colonic polypoid cavernous hemangioma. Recurrent latent bleeding from this lesion could be responsible for the observed mild anemia in this patient. A review of the literature and suggestions for endoscopic treatment are given.

Zusammenfassung

Eine 71-jährige Frau wurde uns zur endoskopischen Untersuchung bei leichtgradiger Anämie mit einem Hb-Wert von 10,7 g/dL (normal ≥ 12 g/dL) zugewiesen. Die Untersuchung des oberen Gastrointestinaltrakts erbrachte keinen pathologischen Befund. Die Koloskopie zeigte im Bereich des linksseitigen Colon transversum einen schmalen, ca. 6 cm langen Polypen mit vereinzelten Erosionen der Oberfläche. Die histologische Untersuchung des resezierten Polypen zeigte das seltene Vorliegen eines polypösen, kavernösen Hämangioms. Rezidivierende Blutungen aus dieser Läsion können die Ursache für die vorliegende Anämie bei der Patientin sein. Eine Übersicht der Literatur sowie Vorschläge zur endoskopischen Therapie werden aufgezeigt.

Schlüsselwörter

gastrointestinale Blutung - polypöses kavernöses Hämangiom - gutartige Darmpolypen

Key words

colonic bleeding - polypoid cavernous hemangioma - benign colonic polyps

• References

• 1 Boo SJ, Byeon JS, Park SY et al. Clipping for the prevention of immediate bleeding after polypectomy of pedunculated polyps: a pilot study. Clin Endosc 2012; 45: 84-88
• 2 Mizukami T, Hiroyuki I, Hibi T. Anchor clip technique helps in easy prevention of post-polypectomy hemorrhage of large colonic polyps. Dig Endosc 2010; 22: 366-369
• 3 Van Deursen CT, Buijs J, Nap M. An uncommon polyp in the colon: a pedunculated cavernous hemangioma. Endoscopy 2008; 40: E127
• 4 Ueda K, Nakase H, Yaku H et al. Pedunculated cavernous hemangioma mimicking inflammatory fibroid polyp in a patient with ulcerative colitis. Endoscopy 2010; 42: E162
• 5 Amano K, Seko A, Nagura K et al. A case of polypoid cavernous hemangioma of the sigmoid colon excised by colonoscopic polypectomy. Gastroenterol Jpn 1993; 28: 712-718
• 6 Liang LC, Forbes N, David J et al. Endoscopic polypectomy of an unusually long polypoid colorectal cavernous hemangioma. Gastrointest Endosc 1998; 47: 307-308
• 7 Cho EY, Choi SC. The cavernous hemangioma of the colon inducing massive hematochezia and treated by endoscopic polypectomy. Korean J Gastroenterol 2005; 45: 379-380
• 8 Huh JW, Cho SH, Lee JH et al. Large cavernous hemangioma in the cecum treated by laparoscopic ileocecal resection. World J Gastroenterol 2009; 15: 3319-3321
• 9 Livengood JC, Fenoglio ME. Gastrointestinal hemorrhage from a small bowel polypoid hemangioma. JSLS 2002; 6: 179-180
• 10 Chattopadhyay A, Kumar V, Maruliah M et al. Duodenojejunal obstruction by a hemangioma. Pediatr Surg Int 2002; 18: 501-502
• 11 Geraci G, Pisello F, Arnone E et al. Endoscopic resection of a large colonic lipoma: case report and Review of literature. Case Rep Gastroenterol 2010; 4: 6-11
• 12 Paoluzi OA, Tosti C, Andrei F et al. Look out before polypectomy in patients with diverticular disease – a case of a large, inverted diverticulum of the colon resembling a pdunculated polyp. Can J Gastroenterol 2010; 24: 61-63