SciELO - Scientific Electronic Library Online

vol.106 issue3Deep infiltrating rectosigmoid endometriosis: diagnostic keysInsertion of self-expanding metal stent for treatment of malignant obstruction in a pregnant woman author indexsubject indexarticles search
Home Pagealphabetic serial listing  


Services on Demand




Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google


Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Rev. esp. enferm. dig. vol.106 n.3 Madrid Mar. 2014




Cavernous hemangioma of small bowel: A rare cause of digestive hemorrhage

Hemangioma cavernoso del intestino delgado: una causa rara de hemorragia digestiva



Dália Fernandes1,3, Isabel Dionísio2, Sofia Neves2 and Patrícia Duarte1,3

Departments of 1Gastroenterology and 2Surgery. Cova da Beira Hospital Center. Covilhã, Portugal. 3Health Sciences Faculty. University of Beira Interior. Covilhã, Portugal




Gastrointestinal hemangiomas are rare benign tumors, representing 0.05 % of all gastrointestinal tumors, that may appear isolated or as part of systemic vascular disorders (1). They are more frequent in the jejunum. Their main clinical manifestation is gastrointestinal bleeding, usually insidious in capillary hemangiomas, although it can be acute and severe in the cavernous type (2). Other forms of presentation can be obstruction, intussusception, intramural hematoma, perforation and platelet sequestration (3). Endoscopy is the method of choice in the diagnosis of such lesions, and the capsule endoscopy the gold standard for small bowel lesions (4). Surgical resection is the ideal treatment.


Case report

We presented a 56-year-old woman who was admitted to the emergency room with hematochezia and syncope, of 24 hours of duration. She denied abdominal pain and referred recent use of ibuprofen. Physical examination on admission only revealed cutaneous-mucous pallor. Laboratory analyses revealed microcytic and hypochromic anemia (HGB 9.4 g/dL, MCV 78.1 fL and MCHC 33.7 g/dL). Upper gastrointestinal endoscopy showed none bleeding lesion. Fibrosigmoidoscopy showed abundant blood and clots on the lumen, but colonoscopy with ileoscopy on the following day detected none trace of blood or bleeding lesion. One week later a capsule endoscopy was perfomed and identified a large, violet-colored and circumferential lesion in the ileum, conditioning luminal stenosis, without active bleeding (Fig. 1). Computed tomography enterography demonstrated a 14 centimeter-long irregular thickening of the ileum, with focal calcifications (Fig. 2). A laparotomy was performed and the vascular tumor was confirmed and resected (Fig. 3). Histological examination revealed a cavernous hemangioma (Fig. 4). The surgery and postoperative period was uneventful.




Although there are some case reports of gastrointestinal bleeding due to hemangiomas in the literature, this case stands out because of large size of hemangioma and its presentation as overt gastrointestinal bleeding at an advanced age.



1. Boyle L, Lack EE. Solitary cavernous hemangioma of small intestine. Case report and literature review. Arch Pathol Lab Med 1993;117:939-41.         [ Links ]

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;177:1073-81.         [ Links ]

3. Pera M, Márquez L, Dedeu JM, Sánchez J, Garcia M, Ramón JM, et al. Solitary cavernous hemangioma of the small intestine as the cause of long-standing iron deficiency anemia. World J Gastrointest Surg 2012;16:2288-90.         [ Links ]

4. De Mascarenhas-Saraiva MN, da Silva Araújo Lopes LM. Small-bowel tumors diagnosed by wireless capsule endoscopy: report of five cases. Endoscopy 2003;35:865-8.         [ Links ]

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License