SciELO - Scientific Electronic Library Online

vol.104 número5Enfermedad de WhipplePapel de la ecografía contrastada en la estadificación clínica del cáncer de páncreas índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados




Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google


Revista Española de Enfermedades Digestivas

versión impresa ISSN 1130-0108

Rev. esp. enferm. dig. vol.104 no.5 Madrid may. 2012 



Small bowel giant cavernous hemangioma diagnosed by capsule endoscopy

Hemangioma cavernoso gigante del intestino delgado diagnosticado por cápsula endoscópica


Key words: Giant cavernous hemangioma. Capsule endoscopy.

Palabras clave: Hemangioma cavernoso gigante. Cápsula endoscópica.


Dear Editor,

Hemangiomas are congenital benign vascular lesions that can be classified as capillary, cavernous, or mixed type. Whereas some involute after birth, many others persist throughout life and some become symptomatic decades after birth. We report the case of a patient with iron deficiency anemia of unknown etiology since childhood whose diagnosis was made by capsule endoscopy.


Case report

A 19-years old man with iron deficiency anemia had been followed up at the Department of Pediatrics since the age of 5-years old. The patient underwent upper and lower GI endoscopy, small bowel barium follow-through and Meckel's diverticulum scintigraphy, which were all negative. He has been all these years on oral iron therapy but otherwise asymptomatic. The patient was referred to the department of Gastroenterology for follow up and study. Initial diagnostic tests (upper and lower GI endoscopy and small bowel barium follow-through) were repeated, but they did not yield any diagnosis. An abdominal CT scan showed an 8 centimeter-long concentric mural thickening of the ileum with homogeneous enhancement of its wall. The findings suggested the diagnosis of Crohn's disease, but the radiologist was unable to rule-out intestinal lymphoma. The patient refused a study with capsule endoscopy and, therefore, we started empirical treatment with 5-ASA and intravenous iron.

The patient was admitted to the hospital two months later for severe anemia (hemoglobin: 4.8 g/dL) with several episodes of melena at home. This time he accepted to undergo a capsule endoscopy study. The study showed a large violet-colored polypoid submucosal lesion at the proximal ileum. The lesion occluded half of the lumen of the bowel and oozing bleeding was seen coming from the lesion (Fig. 1).



At laparotomy a purple-colored, well-vascularized tumor of 10 cm in length was resected (Fig. 2). The histological study demonstrated that the tumor was a giant cavernous hemangioma (Fig. 3). The patient was discharged five days after surgery. The patient has remained asymptomatic and with normal laboratory blood counts since then.





We report the case of a young patient with iron deficiency anemia of unknown etiology since childhood. The anemia was caused by a giant cavernous hemangioma, diagnosed by capsule endoscopy. Hemangiomas are benign congenital vascular lesions that may appear isolated or as a part of syndromes (i.e. blue rubber bled nevus syndrome) (1). The most frequent location of gastrointestinal cavernous hemangiomas is the small intestine (mainly jejunum), followed by the colon, especially the rectosigmoid. The most common clinical presentation is obscure gastrointestinal bleeding, either occult or visible (2,3), although obstruction, intussusception, and perforation may occur. The treatment of choice is surgical resection of the lesion. The interest of this case lies not only in its rarity, but also on the role of capsule endoscopy for the correct diagnosis and subsequent management of the patient.


Antonio Guardiola1, Javier Navajas1, Julio Valle1, Rafael López-Pardo2, Rufo Rodríguez-Merlo3, María del Mar Lombera1 and Mariano Alcántara1
1Department of Digestive Diseases, 2General Surgery and 3Patology. Hospital Virgen de la Salud. Toledo, Spain



1. Dwivedi M, Misra SP, FRCP. Blue rubber bled nevus syndrome causing upper GI hemorrhage: a novel management approach and review. Gastrointestinal Endoscopy 2002;55(7):943-6.         [ Links ]

2. Pinho R, Rodrigues A, Proença L, Silva AP, Fernandes S, Leite S, et al. Solitary hemangioma of the small bowel disclosed by wireless capsule endoscopy. Gastroenterol Clin Biol. 2008; 2(1 Pt. 1):15-8.         [ Links ]

3. Chen CH, Jones J, McGowan P. Profound iron deficiency anemia caused by a small-intestinal cavernous hemangioma. Gastrointest Endosc. 2009;69(7):1392-3.         [ Links ]

Creative Commons License Todo el contenido de esta revista, excepto dónde está identificado, está bajo una Licencia Creative Commons