Case Report

A Rare Case of Jejunal Lymphangioma Presenting with Obscure Gastrointestinal Bleeding

Lee-Won Chong1,2, Chin-Chu Wu3, Shu-Han Huang4, Cheuk-Kay Sun1,2,5*

1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan

2School of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan

3Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan

4Department of Pathology and Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan

5Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 24205, Taiwan

*Corresponding author: Cheuk-Kay Sun, Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan

Received Date: 24 May 2023

Accepted Date: 29 May 2023

Published Date: 31 May 2023

Citation: Chong LW, Wu CC, Huang SH, Sun CK (2023) A Rare Case of Jejunal Lymphangioma Presenting with Obscure Gastrointestinal Bleeding. Ann Case Report. 8: 1326. https://doi.org/10.29011/2574-7754.101326

Abstract

Small bowel lymphangiomas are rare benign tumours of the lymphatic system. Most lymphangiomas are asymptomatic and do not require treatment. Resection is required for patients with bleeding, intestinal obstruction, and intussusception. Obscure gastrointestinal bleeding poses a medical challenge for physicians. We report a case of jejunal lymphangioma diagnosed using video capsule endoscopy and treated with surgical resection in a 36-year-old woman with obscure gastrointestinal bleeding.

Keywords: Lymphangioma; Small Intestine; Video Capsule Endoscopy

Introduction

A lymphangioma is a benign tumour caused by dilatation of the lymphatic channels. Lymphangiomas typically occur in the head, neck, and axillary areas, as well as in parenchymal organs such as the spleen, liver, and bone. However, they rarely occur in the gastrointestinal tract, and they are especially rare in the small intestine. Lymphangiomas may occur during childhood and are thought to represent congenital malformations of the lymphatic spaces that form during early development. They may experience secondary changes as a result of inflammation, fibrosis, or obstruction of the lymphatic spaces. Lymphangiomas represent 6% and 1.4% to 2.4% of all small bowel tumours in children [1] and adults [2], respectively. Small bowel lymphangiomas are commonly asymptomatic when they are small; however, their enlargement can cause abdominal pain secondary to intestinal irritation, followed by gastrointestinal bleeding, anemia, intestinal obstruction, intussusception, and protein-losing enteropathy [3-5]. Obscure gastrointestinal bleeding (OGIB) remains challenging for gastroenterologists. However, more cases of small bowel lymphangiomas have been observed since the advent of video capsule endoscopy (VCE) and enteroscopy. We report a rare case of jejunal lymphangioma that was diagnosed using VCE and treated with surgical resection.

Case Presentation

We observed a case of jejunal lymphangioma in a 36-year-old woman who presented with OGIB. She had a 1-year history of dyspnea on exertion and iron-deficiency anemia. Her complete blood count revealed severe anemia (hemoglobin, 5.1 g/dL), and the fecal occult blood test result was positive. Although esophagogastroduodenoscopic and colonoscopic examinations and computed tomography evaluations were performed at another hospital, the source of bleeding was not identified. She was referred to our hospital for capsule endoscopy. Capsule endoscopy (MiroCamĀ®; IntroMedic, Minneapolis, MN, USA) revealed an actively bleeding polypoid lesion within the jejunum (Figure 1A). Enteroscopy showed a 1.6-cm polypoid lesion with white spots and a blood clot on the surface that was oozing at the proximal jejunum (Figure 1B). Two hemoclips were applied to the opposite side of the tumour. The patient underwent exploratory laparotomy with tumour resection (Figure 1C).


Figure 1: A: Capsule endoscopy reveals a polypoid lesion covered with white spots and active hemorrhage within the jejunum. 1B: Enteroscopy shows a 1.6-cm polypoid lesion with a broad base, white spots, and a blood clot on the surface that is oozing at the proximal jejunum. It is occupying almost half of the lumen. 1C: A tumor with hemorrhage is noted at the jejunum at 30 cm distal to the Treitz ligament.