Year 2020 / Volume 112 / Number 4
Digestive Diseases Image
Obscure gastrointestinal bleeding in the setting of blue rubber bleb nevus syndrome with extensive small bowel involvement

323-324

DOI: 10.17235/reed.2020.6963/2020

João Carlos Silva, Edgar Afecto, Adelia Rodrigues, Rolando Pinho,

Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by multiple vascular malformations of the gastrointestinal (GI) tract, skin and less frequently in solid organs. An 85-year-old male was admitted to the ER due to melena and was under apixaban anticoagulation. Dorsal hemangiomas were identified on physical examination. On admission, he had hemoglobin levels of 7.6g/dl, esophagogastroduodenoscopy was negative and colonoscopy revealed blood clots in all segments, including the terminal ileum. Capsule endoscopy revealed multiple polypoid vinaceous-colored formations in the proximal jejunum and distally active bleeding resulting in limited mucosal observation. The abdominal-CT was normal. Balloon-assisted enteroscopy (BAE) allowed the identification of multiple hemangioma-like purplish blue lesions in the jejunum and ileum without active bleeding. A diagnosis of BRBNS was made based on clinical, imaging and endoscopic findings. Supportive treatment was decided, considering the extent of the lesions and the comorbidities of the patient. Treatment depends on the site, size and number of lesions. Surgical resection is more suitable for limited or life-threatening lesions. Endoscopic treatment with polidocanol, coagulation, band ligation and endoscopic mucosal resection are also available. Sirolimus has been successfully used. However, tolerability and adverse effects limits its use as a rescue therapy.
Share Button
New comment
Comments
No comments for this article
References
Chen, W., Chen, H., Shan, G., et al., Blue rubber bleb nevus syndrome: our experience and new endoscopic management. Medicine (Baltimore), 2017. 96(33): p. e7792.
Li, A., F.X. Chen, and Y.Q. Li, An Unusual Cause of Recurrent Melena. Gastroenterology, 2019. 157(2): p. 311-312.
Pérez-Cuadrado ME. and Pérez-Cuadrado Robles E., Advanced therapy by device-assisted enteroscopy. Rev Esp Enferm Digest., 2020. In press.
Related articles

Letter

Jejunal gastrointestinal stromal tumor: a diagnostic challenge

DOI: 10.17235/reed.2024.10108/2023

Letter

Blue rubber bleb nevus syndrome

DOI: 10.17235/reed.2023.9913/2023

Digestive Diseases Image

Enteroenteric intussusception caused by a small bowel metastatic cutaneous melanoma

DOI: 10.17235/reed.2023.9876/2023

Letter

Capsule endoscopy diagnosis of gastrointestinal melanoma

DOI: 10.17235/reed.2023.9803/2023

Letter

Isolated Jejunal Crohn's Disease: a challenging diagnosis

DOI: 10.17235/reed.2022.9423/2022

Digestive Diseases Image

Whipple’s disease – A typical endoscopic finding of a rare disease

DOI: 10.17235/reed.2022.9338/2022

Letter

Primary intestinal melanoma?

DOI: 10.17235/reed.2022.8944/2022

Digestive Diseases Image

Ileal neuroendocrine tumor as an uncommon cause of obscure gastrointestinal bleeding

DOI: 10.17235/reed.2022.8641/2022

Letter

An unusual cause of anemia: Bean syndrome

DOI: 10.17235/reed.2021.8522/2021

Digestive Diseases Image

Duodenal-type follicular lymphoma: a silent tumor

DOI: 10.17235/reed.2021.8149/2021

Letter

Bochdalek hernia: use of capsule endoscopy

DOI: 10.17235/reed.2021.7760/2020

Review

Advanced therapy by device-assisted enteroscopy

DOI: 10.17235/reed.2020.6971/2020

Digestive Diseases Image

Gastrointestinal and renal involvement in systemic vasculitis

DOI: 10.17235/reed.2020.6965/2020

Editorial

Does it matter how long the small bowel is?

DOI: 10.17235/reed.2020.6980/2020

Digestive Diseases Image

Enteroscopy in the diagnosis of melanoma metastases

DOI: 10.17235/reed.2020.6820/2019

Digestive Diseases Image

Enteroscopic diagnosis of intestinal malabsorption of a rare etiology: diaphragm disease

DOI: 10.17235/reed.2020.6723/2019

Digestive Diseases Image

Jejunal schwannoma detected by video capsule endoscopy

DOI: 10.17235/reed.2020.6474/2019

Digestive Diseases Image

Capsule endoscopy, a useful tool for the diagnosis of a tapeworm infection

DOI: 10.17235/reed.2019.6346/2019

Letter

Use of patency capsule in daily practice

DOI: 10.17235/reed.2019.5952/2018

Digestive Diseases Image

Metastasis of dermatofibrosarcoma diagnosed by capsule endoscopy

DOI: 10.17235/reed.2018.4900/2017

Letter to the Editor

Symptomatic retention of the Agile® patency capsule

DOI: 10.17235/reed.2017.4691/2016

Letter to the Editor

Whipple’s disease under the vision of capsule endoscopy

DOI: 10.17235/reed.2016.4362/2016

Letter to the Editor

Asymptomatic bronchial aspiration of capsule endoscope: a significant complication

DOI: 10.17235/reed.2016.4363/2016

Case Report

Atypical diagnosis diagnosis by endoscopic capsule: Whipple´s disease

DOI: 10.17235/reed.2015.3718/2015

Citation tools
Silva J, Afecto E, Rodrigues A, Pinho R. Obscure gastrointestinal bleeding in the setting of blue rubber bleb nevus syndrome with extensive small bowel involvement. 6963/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1431 visits.
This article has been downloaded 228 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 11/02/2020

Accepted: 04/03/2020

Online First: 23/03/2020

Published: 07/04/2020

Article revision time: 18 days

Article Online First time: 41 days

Article editing time: 56 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology