68 years old male presents with tarry stools and anemia.
Physical examination was age-appropriate.
Laboratory: Microcytic anemia, otherwise unremarkable.
EGD and Ileo-Coloscopy didn´t show a bleeding source.
MRI-Sellink: Atypically extended upper jejunal loops behind ligament of Treitz
Upper Jejunoscopy (Olympus CF160I) 10cm behind ligament of Treitz.
Macroscopic polypoid, partly whitish spotted deposits. Biopsy leads to massive bleeding.
Small intestine lymphangiomas are a very rare benign disease with only case histories in the literature. Frequently, small intestinal lymphangiomas are first diagnosed intraoperatively with recurrent GI bleeding or in connection with the more frequent mesenteric lymphangiomas.
Usually, lymphangiomas are manifested in the first decade of life. Smaller abdominal lymphangiomas are often clinically manifested in the 6th decade of life with bleeding.
A congenital missing communication among the lymph vessels and with the venous system is discussed. Communication with the venous system often leads to a significant bleeding tendency during mechanical alteration. A transition to malignomas is not established.
Treatment of choice is the resection. In case of a predominantly large cystic lymphangioma, sclerotherapy (OK432) may be appropriate. Irradiations are ineffective and associated with a high degeneracy risk.
Ugwonali O, Coady M, Saxena R, et al.
Intraoperative enteroscopy for diagnosis of a bleeding jejunal lymphangioma.
J Clin Gastroenterol (United States), Dec 2000, 31(4) p333-5
Calvo AM, Erce R, Monton S, et al.
[Cavernous haemangioma of the small bowel: an uncommon cause of intestinal obstruction]
An Sist Sanit Navar (Spain), Sep-Dec 2003, 26(3) p437-40
Amadori G, Micciolo R, Poletti A
A case of intra-abdominal multiple lymphangiomas in an adult in whom the immunological evaluation supported the diagnosis.
Eur J Gastroenterol Hepatol (England), Mar 1999, 11(3) p347-51
Honda K, Ihara E, Ochiai T, et al.
Lymphangioma of small intestine.
Gastrointest Endosc (United States), Oct 2003, 58(4) p574-5
Yao S, Esaki M, Matsumoto T, et al.
Multiple lymphangiomas of the small intestine.
Gastrointest Endosc (United States), Oct 2001, 54(4) p491-2
Kim HS, Lee SY, Lee YD, et al.
J Korean Med Sci (Korea (south)), Apr 2001, 16(2) p229-32v