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

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.