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Sung K, Lu C, Wang Y. An unusual cause of obscure gastrointestinal bleeding. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kuang‐Yi Sung
- Endoscopy Center For Diagnosis and Treatment Taipei Veterans General Hospital Taipei Taiwan
- Division of Gastroenterology, Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Ching‐Liang Lu
- Endoscopy Center For Diagnosis and Treatment Taipei Veterans General Hospital Taipei Taiwan
- Division of Gastroenterology, Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
- Institute of Brain Science, School of Medicine National Yang‐Ming University Taipei Taiwan
- Department of Medicine, School of Medicine National Yang‐Ming University Taipei Taiwan
| | - Yen‐Po Wang
- Endoscopy Center For Diagnosis and Treatment Taipei Veterans General Hospital Taipei Taiwan
- Division of Gastroenterology, Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
- Institute of Brain Science, School of Medicine National Yang‐Ming University Taipei Taiwan
- Department of Medicine, School of Medicine National Yang‐Ming University Taipei Taiwan
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Hayashi Y, Hosoe N, Takabayashi K, Kamiya KJL, Mutaguchi M, Miyanaga R, Hirata K, Fukuhara S, Mikami Y, Sujino T, Masugi Y, Naganuma M, Ogata H, Kanai T. Clinical and Endoscopic Characteristics of Pyogenic Granuloma in the Small Intestine: A Case Series with Literature Review. Intern Med 2020; 59:501-505. [PMID: 31611535 PMCID: PMC7056362 DOI: 10.2169/internalmedicine.3745-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pyogenic granuloma (PG) generally appears in the skin or oral cavity, but rarely occurs in the small intestine, where it can cause bleeding. To date, only 35 cases of small intestinal PG have been reported in the English literature. We retrospectively collected information from the clinical records of seven cases of small intestinal PG that were managed in our hospital and summarized the characteristics. Further information on the clinical characteristics was obtained from the literature. Capsule endoscopy, useful for identifying the source of hemorrhage in obscure gastrointestinal bleeding, can detect PGs. Treatment can often be accomplished with endoscopic mucosal resection.
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Affiliation(s)
- Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Kenji Jl Limpias Kamiya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Makoto Mutaguchi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Ryoichi Miyanaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Seiichiro Fukuhara
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Tomohisa Sujino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Japan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
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Romero Mascarell C, García Pagán JC, Araujo IK, Llach J, González-Suárez B. Pyogenic granuloma in the jejunum successfully removed by single-balloon enteroscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:152-154. [PMID: 28196424 DOI: 10.17235/reed.2017.4153/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pyogenic granuloma is a non-infectious and non-granulomatous lesion. Its location in the small bowel is very rare. We present a 46 year-old woman with a chronic liver disorder that had a severe chronic anemia with occult blood losses. Upper endoscopy and colonoscopy were normal. A small bowel capsule endoscopy showed a pyogenic granuloma in jejunum that was resected endoscopically with single balloon enteroscopy with no major complications. The patient recovered from anemia and six months latter capsule endoscopy did not show lesions.
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Affiliation(s)
| | | | - Isis Karina Araujo
- Endoscopy Unit. Gastroenterology Department. , Hospital Clinic, Barcelona
| | - Josep Llach
- Endoscopy Unit. Gastroenterology Department. , Hospital Clinic, Barcelona
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De María J, Curvale C, Guidi M, Hwang H, Matanó R. Pyogenic granuloma of the jejunum; diagnosis and treatment with double-balloon enteroscopy: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gastrointestinal Pyogenic Granuloma (Lobular Capillary Hemangioma): An Underrecognized Entity Causing Iron Deficiency Anemia. Case Rep Gastrointest Med 2016; 2016:4398401. [PMID: 27403353 PMCID: PMC4925958 DOI: 10.1155/2016/4398401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 11/17/2022] Open
Abstract
Pyogenic granuloma (PG), more accurately known as lobular capillary hemangioma, is a benign vascular tumor that usually occurs in the skin or oral mucosa. This lesion is rarely reported in the gastrointestinal tract but is known to bleed if not resected. We herein describe a case series with the clinical, endoscopic, and histologic findings of four cases of gastrointestinal PG at our institution. In addition, we provide a review of the literature and summation of all reported cases of PG specific to the gastrointestinal tract. Based on our experience, we suggest that the actual incidence of gastrointestinal PG may in fact be higher than reported because PG can be unrecognized or improperly diagnosed. It is important for the clinician to properly recognize this lesion as a source of anemia and its propensity to bleed during biopsy or resection.
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De María J, Curvale C, Guidi M, Hwang H, Matanó R. Pyogenic granuloma of the jejunum; diagnosis and treatment with double-balloon enteroscopy: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 82:94-96. [PMID: 27161794 DOI: 10.1016/j.rgmx.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/11/2015] [Accepted: 10/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J De María
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
| | - C Curvale
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina.
| | - M Guidi
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
| | - H Hwang
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
| | - R Matanó
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red El Cruce «Dr. Néstor Carlos Kirchner», Florencio Varela, Buenos Aires, República Argentina
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Misawa SI, Sakamoto H, Kurogochi A, Kirii Y, Nakamura S, Misawa T, Yoneda S, Hirano M, Owa O, Takagi H, Ota H. Rare cause of severe anemia due to pyogenic granuloma in the jejunum. BMC Gastroenterol 2015; 15:126. [PMID: 26444414 PMCID: PMC4596517 DOI: 10.1186/s12876-015-0355-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pyogenic granuloma (PG) is a polypoid lobular capillary hemangioma rarely observed in the gastrointestinal tract. Only a few cases in the small bowel have been described in the literature. CASE PRESENTATION A 58-year-old man had been suffering from general fatigue and severe anemia. Esophagogastroduodenoscopy and colonoscopy did not reveal any significant bleeding. Abdominal computer tomography revealed a hypervascular tumor in the small intestine. Oral double-balloon endoscopy (DBE) detected a polypoid lesion (2 cm in diameter) in the jejunum. We performed laparoscopic-assisted partial resection of the jejunum. The histological features of the tumor were consistent with PG. The patient's anemia gradually improved without the need for oral iron after surgery. CONCLUSION In this case report, we present a case of pyogenic granuloma in in the jejunum that was detected by DBE.
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Affiliation(s)
- Shun-Ichi Misawa
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Hiroto Sakamoto
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Akira Kurogochi
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Yasushi Kirii
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Shinichiro Nakamura
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Tomoko Misawa
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Suguru Yoneda
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Mari Hirano
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Osamu Owa
- Department of Gastroenterology, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Hiroyuki Takagi
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano, 3901401, Japan.
| | - Hiroyoshi Ota
- Department of Biomedical Laboratory Sciences, Shinshu University, School of Medicine, 3-1-1 Asahi, Matsumoto, 3908621, Nagano, Japan.
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Obscure gastrointestinal bleeding: resection of a pyogenic granuloma of the ileum via double-balloon enteroscopy. Clin J Gastroenterol 2015; 7:397-401. [PMID: 26184018 DOI: 10.1007/s12328-014-0524-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
Pyogenic granulomas usually occur on the skin or oral mucosa; however, they rarely develop in the gastrointestinal tract, particularly in the ileum. We report the case of an 82-year-old female who experienced occasional bloody stools. Initially, no significant bleeding source could be identified via conventional endoscopy; however, repeat capsule endoscopy identified a bleeding polyp (8 mm) in the ileum. Therefore, we resected the polyp via double-balloon enteroscopy. Histopathological findings showed increased, lobulated, and enlarged capillaries and desquamated epithelium indicative of epithelial erosion. In addition, neutrophil-predominant inflammatory cell infiltrate and interstitial edema were observed in the intercapillary stroma. Immunohistochemical analysis showed positive staining for vascular endothelial cell markers. Previous reports have mentioned that pyogenic granulomas in the oral cavity were associated with the female hormonal receptor, vascular endothelial growth factor, and proliferative immune markers; however, no significant staining was observed in our patient. This is the first report discussing an association between pyogenic granulomas and these markers. Pyogenic granulomas in the ileum are rare and may cause fatal anemia. Pyogenic granulomas should be considered in the differential diagnosis of obscure gastrointestinal bleeding.
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Kikuchi A, Sujino T, Yamaoka M, Yoneno K, Ohgo H, Takagi M, Morioka S, Hirooka E, Yamamoto K, Shinozuka N, Honma T, Kayano H, Nakamoto H, Imaeda H. Pyogenic granuloma of the ileum diagnosed by double-balloon enteroscopy. Intern Med 2014; 53:2057-9. [PMID: 25224187 DOI: 10.2169/internalmedicine.53.2468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A pyogenic granuloma (PG) is a capillary hemangioma that usually occurs on the skin or in the oral cavity; it is rarely observed in the gastrointestinal tract. We herein describe a case of a 86-year-old woman who presented with anemia. Esophagogastroduodenoscopy and colonoscopy did not reveal any significant bleeding focus, but capsule endoscopy revealed a bleeding focus in the small intestine. We performed double-balloon enteroscopy and identified a 7-mm-diameter, reddish, subpedunculated, hemispheric polyp with a smooth surface in the small intestine, approximately 100 cm from the ileocecal valve. The polyp was surgically removed, and the histological findings were consistent with a diagnosis of PG.
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Affiliation(s)
- Azusa Kikuchi
- Department of General Internal Medicine, Saitama Medical University, Japan
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Castle SL, Naik-Mathuria BJ, Kawaguchi AL, Shaul DB. Management of rectal pyogenic granuloma with transanal mucosal sleeve resection. J Pediatr Surg 2012; 47:1754-6. [PMID: 22974618 DOI: 10.1016/j.jpedsurg.2012.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/14/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022]
Abstract
In children, pyogenic granulomas are most commonly cutaneous benign vascular lesions but can also present in the gastrointestinal tract. When they occur in the intestine, they can cause acute or chronic gastrointestinal bleeding. We present an unusual case of rectal pyogenic granuloma and our management strategy.
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Chou JW, Lai HC, Lin YC. Image of the month. Pyogenic granuloma of the small bowel diagnosed by capsule endoscopy and double-balloon enteroscopy. Clin Gastroenterol Hepatol 2009; 7:A26. [PMID: 19056516 DOI: 10.1016/j.cgh.2008.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 10/30/2008] [Accepted: 10/31/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Pyogenic granuloma: an unusual cause of massive gastrointestinal bleeding from the small bowel. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:261-4. [PMID: 19373418 DOI: 10.1155/2009/579163] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal bleed, and reviews the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare gastrointestinal lesion.
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