|Year : 1997 | Volume
| Issue : 3 | Page : 97-99
Solitary cavernous haemangioma of the jejunum with intra-abdominal bleeding - Case report
Radha R Pai, Flora D Lobo, Hema Kini, R Ballal, A Kini, CV Raghuveer
Department of Pathology and General Surgery, Kasturba Medical College and Hospitals Mangalore-575 001., India
Radha R Pai
Department of Pathology and General Surgery, Kasturba Medical College and Hospitals Mangalore-575 001.
|How to cite this article:|
Pai RR, Lobo FD, Kini H, Ballal R, Kini A, Raghuveer C V. Solitary cavernous haemangioma of the jejunum with intra-abdominal bleeding - Case report. Indian J Med Sci 1997;51:97-9
|How to cite this URL:|
Pai RR, Lobo FD, Kini H, Ballal R, Kini A, Raghuveer C V. Solitary cavernous haemangioma of the jejunum with intra-abdominal bleeding - Case report. Indian J Med Sci [serial online] 1997 [cited 2013 Dec 5];51:97-9. Available from: http://www.indianjmedsci.org/text.asp?1997/51/3/97/11524
Haemangiomas are rare lesions in the gastrointestinal tract. The overall incidence is about 1:14000 patients, and those of small bowel form 3 to 4% of all tumours of the small bowel and 0.3% of all tumours of the gastrointestinal tract.  The diagnosis is most often an incidental finding either at laparotomy or at autopsy. A preoperative diagnosis of haemangioma is rarely made since the symptoms produced are highly variable and difficult to interpret. Herein we describe a very interesting case of solitary cavernous haemangioma of the jejunum in a 38 year old male, presenting with clinical features of amoebic colitis. A mass lesion was detected on ultrasonography. At laparotomy the vascular lesion was identified with intraperitoneal rupture and haematoma formation. Diagnosis was revealed only on histopathological examination.
| ¤ Case Report|| |
A 38 year old male was admitted with history of pain in abdomen and loose stools since one month. Pain was dull aching and localised to the right iliac fossa. Blood and mucus were present in the stools. There was no history of vomiting. A differential diagnosis of amoebic colitis and ulcerative colitis were considered.
On examination pallor was present, pulse was 100/minute and blood pressure 130/80 mmHg. Per abdominal examination revealed tenderness in the right iliac fossa with mild guarding. On auscultation sluggish bowel sounds were heard. Rectum was empty on per rectal examination. CVS and RS were within normal limits. Plain X-ray abdomen was normal. Abdominal ultrasonography showed features of peritonitis with pelvic collection and a mass lesion in the right iliac fossa. Exploratory laparotomy was performed and the toneal cavity with oedematous findings were : blood in the perismall intestine, a haematoma contained by omentum and a haemorrhagic perforating growth in the jejunum 20 cms from the duodenojejunal flexure. Liver was normal. Blood was sucked out, haematoma evacuated and the omentum was divided and ligated. Jejunum with the tumour was resected and end-to-end anastomosis performed. Postoperative recovery was uneventful.
Grossly the specimen consisted of resected small intestine measuring 20 cmm in length. Serosal aspect showed an irregular haemorrhagic nodular area measuring 5 cm in diameter which on cut surface was seen extending into the submucosa giving a polypoidal appearance on the mucosal aspect. The immediate adjacent mucosa appeared normal [Figure 1]. Microscopically sections through ,the leson showed large area of haemorrhage expanding the submucosa with perforation through the muscular layer. The overlying mucosa was intact except for oedema and haemorrhage. Large covernous blood filled spaces lined by flattened cells were seen in the submucosa at the periphery of the lesion. A diagnosis of cavernous haemangioma with intraperitoneal rupture was made.
| ¤ Discussion|| |
On review of literature the various symptom-complexes produced by small intestinal haemorrhage occult or massive, small bowel obstruction (partial or complete) and inflammation of the lesion simulating acute appendicitis. If the lesion is large and polypoidal intussusception may occur.  Intraperitoneal rupture has been described as an unusual complication.  The commonest symptom however is that of bleeding from the bowel causing anaemia.  These different modes of presentation makes a preoperative diagnosis difficult. Three cases of polypoid haemangioma of the small intestine were located in the Indian Literature 2 presenting with intussusception , and one with intractable malena. 
Intestinal haemangioma may be solitary or multiple.  If cutaneous haemangiomas are present as in the case of haemangiomatosis the intestinal lesions are usually multiple. Grossly they form a polypoid mass or a diffuse infiltrating lesion. They are usually soft, red, blue or wine coloured. Rarely the tumour forms a constricting almost circumferential mass. Dumbbell shaped tumours are described.  Midjejunum is the most common location.  In our case he tumour was in the jejunum 20 cms away from the duodenojejunal flexure. Microscopically cavernous haemangioma is the most common followed by capillary and mixed capillary-cavernous haemangioma in equal proportion.  Several emphasize that a preoperative diagnosis of intestinal haemangioma is never easy. Despite the rarity of this entity, it should be considered in the differential diagnosis of gastrointestinal bleeding of unknown origin both in adults and childhood. According to Hansen  the diagnosis will be more frequently made if due attention is paid to the following : 1)Presence of haemangioma on the skin and mucous membrane. 2) Presence of phlepboliths on X-ray. 3) The significant association of intussusception with polypoid haemangioma. 4) Presence of indentations and constrictions in the small intestine in cases of otherwise unexplained gastrointestinal haemorrhage.
In conclusion haemorrhage into the abdominal cavity with haematoma formation due to the rupture of an intestinal haemangioma is an extremely unusual occurrence worthy of reporting.
| ¤ References|| |
|1.||Morson & Dawson's Gastrointestinal Pathology 3rd Ed, pp 382-383, London, Blackwell Scientific Publication. 1990. |
|2.||Baruah BD, Naught, Goswami PK. Haernangioma of the ileum with intussusception - Review of the literature and report of a case. Ind J Surg 1958;20:498-503. |
|3.||3 Gastellote Caixal JM, Laengo R, Ledesma L. et al. Intraperitoneal haemorrhage caused by cavernous haemangioma of the small intestine. Rev Esp Enfern Dig 1995;87:155-157. |
|4.||Manchanda RL, Talwar JR. Polypoid haemangioma of the jejunum causing intussusception. Ind J Surg 1957;19:274-276. |
|5.||Mampilly J, Nair VJ, Mathai KM. Polypoid haemangioma of the ileum (A case report). Ind J Surg 1981; 43:674-676. |
|6.||Boyle L, Lack EE. Solitary Cavernous Haemangioma of Small Intestine - Case Report and Literature Review. Arch Pathol Lab Med 1993; 117:939-941. [PUBMED] |
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