Ya-Lin Liu, Hai-Rui Shang, Liang-Bi Xu, Xiao-Wen Xu, Yuan-Xue Ji, Yi-Yang He, Shao-Jie Chen
This case suggests that a small intestinal venous malformation can rarely present as acute obstruction in the absence of bleeding. Contrast-enhanced CT with persistent enhancement pattern is a useful preoperative indicator, and laparoscopy appears to be a feasible approach for both diagnosis and minimally invasive resection. This integrated diagnostic and therapeutic strategy should be considered in select children with small bowel obstruction of uncertain etiology.
BACKGROUND: Small intestinal cavernous hemangiomas are rare vascular malformations that present diagnostic and therapeutic challenges due to their deep location and propensity for recurrent bleeding. This report aims to describe a case with a sequential management approach and to synthesize existing evidence through a narrative literature review.
CASE PRESENTATION: A 74-year-old female presented with recurrent melena for five months. Initial imaging (gastroscopy, colonoscopy, computed tomography angiography, and computed tomography enterography) revealed no bleeding source. Balloon-assisted enteroscopy identified a 0.6 cm mucosal protrusion 520 cm distal to the pylorus, with active oozing. Endoscopic hemostasis was achieved using metal clip occlusion and lauromacrogol sclerotherapy, following which a biopsy was performed safely to confirm the diagnosis of hemangioma. Six months later, melena recurred, and the patient underwent surgical resection of the same lesion. Pathological examination confirmed a cavernous hemangioma. At two-year follow-up, the patient remained free from recurrent gastrointestinal bleeding.
CONCLUSION: This case highlights the value of balloon-assisted enteroscopy for localizing obscure small intestinal bleeding and achieving temporary hemostasis. While endoscopic intervention facilitates diagnosis and acute bleeding control, surgical resection remains the definitive treatment for selected cases. Close follow-up may be considered to monitor for potential recurrence. A narrative review of the literature supports the rarity of this condition and the limited evidence base for treatment standardization.