Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1540
Peer-review started: December 4, 2019
First decision: January 13, 2020
Revised: March 4, 2020
Accepted: March 10, 2020
Article in press: March 10, 2020
Published online: April 7, 2020
Hemolymphangiomas are rare malformations composed of both lymphatic and vascular vessels and are located in the pancreas, spleen, mediastinum, etc. Small intestinal hemolymphangioma is extremely rare and often presents as obscure gastrointestinal bleeding. It is rarely diagnosed correctly before the operation. Endoscopic injection sclerotherapy is usually used as a management of bleeding in esophageal varices and was occasionally reported as a treatment of vascular malformation. The treatment of small intestinal hemolymphangioma with enteroscopic injection sclerotherapy has not been reported.
A 42-year-old male complained of recurrent episodes of melena and dizziness, fatigue and reduced exercise capacity for more than 2 mo. Gastroduodenoscopy and blood test revealed a gastric ulcer and anemia. Treatment with oral proton-pump inhibitors and iron did not improve symptoms. We then performed a capsule endoscopy and anterograde balloon-assisted enteroscopy and revealed a hemolymphangioma. Considering it is a benign tumor without malignant potential, we performed enteroscopic injection sclerotherapy. He was discharged 4 days later. At follow-up 3 mo later, the melena disappeared. Balloon-assisted enteroscopy revealed an atrophied tumor atrophied and no bleeding. Argon plasma coagulation was applied to the surface of the hemolymphangioma to accelerated healing. When he returned for follow-up 1 year later, anemia was resolved and the tumor had been cured.
Balloon-assisted enteroscopy and capsule endoscopy are effective methods for diagnosis of hemolymphangioma. Enteroscopic injection sclerotherapy is an effective treatment.
Core tip: Small intestinal hemolymphangioma is a rare malformation presenting as obscure gastrointestinal bleeding and anemia. Though the malformation has a typical lymphangiectatic appearance of white patches on the mucosal surface, it is rarely diagnosed correctly before the operation. We report a case of intestinal hemolymphangioma diagnosed by capsule endoscopy and balloon-assisted enteroscopy. We applied a new, minimally invasive therapy named enteroscopic injection sclerotherapy to manage this disease, which has been proven to be effective and safe. The literature review can present a better understanding of this disease and the advantage of the new management.