Case Report
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 14, 2012; 18(34): 4798-4800
Published online Sep 14, 2012. doi: 10.3748/wjg.v18.i34.4798
A pedunculated polyp-shaped small-bowel lymphangioma causing gastrointestinal bleeding and treated by double-balloon enteroscopy
Akihiko Kida, Koichiro Matsuda, Satoshi Hirai, Akiyoshi Shimatani, Yousuke Horita, Katsushi Hiramatsu, Mitsuru Matsuda, Hidero Ogino, Shin Ishizawa, Yatsugi Noda
Akihiko Kida, Koichiro Matsuda, Satoshi Hirai, Akiyoshi Shimatani, Yousuke Horita, Katsushi Hiramatsu, Mitsuru Matsuda, Hidero Ogino, Yatsugi Noda, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
Shin Ishizawa, Department of Clinical Pathology, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
Author contributions: Kida A, Matsuda K, Hiramatsu K, Ishizawa S and Noda Y contributed equally to this work; Kida A, Matsuda K, Hirai S, Shimatani A, Horita Y, Hiramatsu K, Matsuda M, Ogino H, Ishizawa S and Noda Y designed research; Kida A, Matsuda K, Hiramatsu K, Ishizawa S and Noda Y performed the research; Kida A and Noda Y contributed to new reagents/analytic tools; Kida A analyzed the data; and Kida A and Noda Y wrote the paper.
Correspondence to: Akihiko Kida, MD, Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama-city, Toyama 930-8550, Japan. kidaakihiko@yahoo.co.jp
Telephone: +81-764-241531 Fax: +81-764-220667
Received: February 1, 2012
Revised: April 25, 2012
Accepted: April 27, 2012
Published online: September 14, 2012
Abstract

We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE). An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital. She was suspected of having bleeding from the jejunum, and was referred to our department for diagnosis and treatment. An oral DBE revealed a 20 mm × 10 mm, regularly surfaced, white to yellowish, elongated, pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz. Since no other source of bleeding was identified by endoscopy in the deep jejunum, an endoscopic polypectomy (EP) was performed for this lesion. A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae. These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions. Although clipping hemostasis was performed during EP, re-bleeding occurred. Finally, a complete hemostasis was achieved by performing an additional argon plasma coagulation.

Keywords: Small-bowel lymphangioma, Gastrointestinal bleeding, Double-balloon enteroscopy