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Intermittent melena and refractory anemia due to jejunal cavernous lymphangioma:A case report

World Journal of Gastrointestinal Surgery 2024年第4期16卷 1208-1214页

作者： Kai-Rui Liu Sheng Zhang Wei-Run Chen You-Xing Huang Xu-Guang Li Department of Abdominal Surgery The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510000Guangdong ProvinceChina Department of General Surgery The Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhou 510000Guangdong ProvinceChina Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China Guangzhou Medical UniversityGuangzhou 510000Guangdong ProvinceChina

BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.

关键词： Intermittent melena Refractory anemia Capsule endoscopy single-balloon enteroscopy Jejunal cavernous lymphangioma Enterectomy Case report

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Computed tomography three-dimensional reconstruction in the diagnosis of bleeding small intestinal polyps:A case report

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World Journal of Clinical Cases 2024年第16期12卷 2831-2836页

作者： Shu-Hui Zhang Ming-Wei Fan Yan Chen Ying-Bin Hu Cheng-Xia Liu Department of Gastroenterology Binzhou Medical University HospitalBinzhou 256600Shandong ProvinceChina

BACKGROUND Computed tomography(CT)small bowel three-dimensional(3D)reconstruction is a powerful tool for the diagnosis of small bowel disease and can clearly show the intestinal lumen and wall as well as the outside structure of the wall.The horizontal axis position can show the best adjacent intestinal tube and the lesion between the intestinal tubes,while the coronal position can show the overall view of the small bowel.The ileal end of the localization of the display of excellent,and easy to quantitative measurement of the affected intestinal segments,the sagittal position for the rectum and the pre-sacral lesions show the best,for the discovery of fistulae is also helpful.Sagittal view can show rectal and presacral lesions and is useful for fistula detection.It is suitable for the assessment of inflammatory bowel disease,such as assessment of disease severity and diagnosis and differential diagnosis of the small bowel and mesenteric space-occupying lesions as well as the judgment of small bowel obstruction points.CASE SUMMARY Bleeding caused by small intestinal polyps is often difficult to diagnose in clinical practice.This study reports a 29-year-old male patient who was admitted to the hospital with black stool and abdominal pain for 3 months.Using the combination of CT-3D reconstruction and capsule endoscopy,the condition was diagnosed correctly,and the polyps were removed using single-balloon enteroscopyendoscopic retrograde cholangiopancreatography without postoperative complications.CONCLUSION The role of CT-3D in gastrointestinal diseases was confirmed.CT-3D can assist in the diagnosis and treatment of gastrointestinal diseases in combination with capsule endoscopy and small intestinal microscopy.

关键词： Computed tomography three-dimensional reconstruction Capsule endoscopy single-balloon enteroscopy Gastrointestinal bleeding Case report

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Ameta-analysis on efficacy and safety:single-balloon vs.double-balloon enteroscopy

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Gastroenterology Report 2015年第2期3卷 148-155页

作者： Vaibhav Wadhwa Saurabh Sethi Sumeet Tewani Sushil Kumar Garg Douglas K.Pleskow Ram Chuttani Tyler M.Berzin Nidhi Sethi Mandeep S.Sawhney Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOHUSA Division of Gastroenterology Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA Division of Basic and Translational Research Department of SurgeryUniversity of MinnesotaMinneapolisMNUSA

Background and aim:Double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)are new techniques capable of providing deep enteroscopy.Results of individual studies comparing these techniques have not been able to identify a superior strategy.Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel.Methods:Databases were searched,including PubMed,Embase,and the Cochrane Central Register of Controlled Trials.The main outcome measures were complete small-bowel visualization,diagnostic yield,therapeutic yield,and complication rate.Statistical analysis was performed using Review Manager(RevMan version 5.2).Meta-analysis was performed using fixed-effect or random-effect methods,depending on the absence or presence of significant heterogeneity.We used the v2 and I2 test to assess heterogeneity between trials.Results were expressed as risk ratios(RR)or mean differences with 95%confidence intervals(CI).Results:Four prospective,randomized,controlled trials with a total of 375 patients were identified.DBE was superior to SBE for visualization of the entire small bowel[pooled RR=0.37(95%CI:0.19–0.73;P=0.004)].DBE and SBE were similar in ability to provide diagnosis[pooled RR=0.95(95%CI:0.77–1.17;P=0.62)].There was no significant difference between DBE and SBE in therapeutic yield[pooled RR=0.78(95%CI:0.59–1.04;P=0.09)]and complication rate[pooled RR=1.08(95%CI:0.28–4.22);P=0.91].Conclusions:DBE was superior to SBE with regard to complete small bowel visualization.DBE was similar to SBE with regard to diagnostic yield,ability to provide treatment and complication rate,but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low tomoderate,due to the small sample size.

关键词： small bowel enteroscopy single-balloon enteroscopy double-balloon enteroscopy meta-analysis outcomes

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Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

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World Journal of Gastrointestinal Endoscopy 2021年第3期13卷 90-96页

作者： Kirill Marakhouski Elena Sharafanovich Uladzislau Kolbik Aleh Sautin Katsiaryna Nikalayeva Aleh Pataleta Kiryl Sanfirau Aliaksandr Svirsky Diagnostic Division Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220113Belarus Department of Elective Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220113Belarus Department of Pediatric Surgery Republican Scientific and Practical Center of Pediatric SurgeryMinsk 220013Belarus

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

关键词： Blue rubber bleb nevus syndrome Bean syndrome single-balloon enteroscopy Children Vascular malformations Gastrointestinal tract Sclerotherapy Aethoxysklerol foam Case report

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