Mid-GI bleeding of Obscure Cause due to a Cavernous Lymphangioma

By Klaus Mönkemüller. MD, PhD, FASGE (USA), FJGES (Japan) 

Professor of Internal Medicine. Virginia Tech Carilion Medical School, Roanoke, USA 

Honorary Professor, Universidad de La República, Montevideo, Uruguay 

Visiting Professor, Faculty of Medicine, University of Belgrade, Serbia 

Case presentation: 

A 32-year-old patient presented with melena and drop in hemoglobin (9 gr/dl). During double balloon enteroscopy a 3 cm yellowish, polypoid lesion with a depressed center was found in the proximal jejunum.  

An India Ink tattoo mark was placed to facilitate its recognition during subsequent operative segmental small bowel resection. 

Discussion: 

Cavernous lymphangiomas are uncommon benign tumors found intra-abdominally, close to the mesentery or in the small bowel. 

Small bowel lymphangiomas can cause gross or occult (obscure) gastrointestinal hemorrhage, anemia, abdominal pain, and/or small bowel obstruction. Endoscopists should be aware of this rare tumor and its ileus due to endoscopic features. Cavernous lymphangiomas may endoscopically mimic neuroendocrine tumors. The ideal treatment is complete resection, as incomplete excision may result in recurrence. There are reports on endoscopic therapy using argon plasma coagulation, injection of sclerosants and endoscopic resection. However, those endoscopic options should be mainly used in small lesions, for palliative purposes or in circumstances when a surgical intervention is not feasible.