Akira Folk, DO1, Aarohi Deshmane, 2, Kirsten Pickard, MD1, Gregory Novak, MD1, Shoma Bommena, MBBS1, Cameron Thompson, MD1, Sasha Taleban, MD, FACG3, Avin Aggarwal, MD1, Rolando J. Leal, MD4 1Banner - University of Arizona Tucson, Tucson, AZ; 2Banner - University of Arizona Tucson, Chandler, AZ; 3University of Arizona College of Medicine, Tucson, AZ; 4Banner University Medical Center, Tucson, AZ Introduction: Small intestinal hemangiomas are rare congenital vascular tumors, accounting for 5-10% of all benign small bowel tumors. They usually present as chronic gastrointestinal bleeding, with the Jejunum being the most commonly affected site. Diagnosing these tumors can be challenging. Here, we report a rare case of jejunal capillary hemangioma that presented as a massive gastrointestinal bleed.
Case Description/
Methods: An 18-year-old male with no prior medical history presented to our institution with symptomatic iron-deficiency anemia with a hemoglobin of 10 g/dL (baseline of 14 g/dL) and two episodes of melena. The initial workup, which included a Meckel’s scan, EGD, and colonoscopy, was inconclusive. Due to ongoing hematochezia and persistent anemia requiring multiple blood transfusions, further evaluation with video capsule endoscopy (VCE) and CT angiography was performed; however, these were non-diagnostic. A tagged RBC scan localized the bleeding to the small bowel. Double balloon enteroscopy (DBE) revealed a vascular appearing jejunal mass (Figure 1A); four hemostatic clips were placed (Figure 1B), and the site was tattooed. Despite temporary improvement, he was re-admitted 10 days later with a hemoglobin level of 5.7 g/dL. Due to worsening symptomatic anemia and concerns about malignancy, he underwent exploratory laparotomy with an intraoperative endoscopy that confirmed the previously identified jejunal lesion without evidence of synchronous lesions. Intraoperatively, a 2.3 x 1.8 x 1.2 cm palpable proximal jejunal mass and mesenteric lymphadenopathy were seen. The patient underwent a small bowel resection with primary jejunojejunostomy. Histopathology confirmed a vascular malformation consistent with intestinal capillary hemangioma with overlying mucosal ulceration (Figure 2). Seventeen regional lymph nodes were benign. Recovery was uncomplicated, and he was discharged in stable condition, with resolution of melena upon follow-up. Discussion: This case highlights the diagnostic and therapeutic challenges of small bowel capillary hemangioma, an uncommon cause of gastrointestinal bleeding, which was successfully treated with surgical resection. While advanced endoscopic techniques—including VCE, DBE, and push enteroscopy—can be helpful in locating the lesion and achieving hemostasis through endoscopic intervention, as in our case, histological examination of the surgically resected specimen is typically necessary for definitive diagnosis.
Figure: Figure 1. (A) Small bowel enteroscopy revealing 6-8mm mass with stigmata of recent bleeding located in the proximal jejunum. (B) Successful placement of four hemostatic clips placed at base of the jejunum mass for hemostasis.
Figure: Figure 2. Jejunal mass comprised of thin-walled vessels beneath ulcerated, reactive mucosa with associated chronic inflammation.
Disclosures: Akira Folk indicated no relevant financial relationships. Aarohi Deshmane indicated no relevant financial relationships. Kirsten Pickard indicated no relevant financial relationships. Gregory Novak indicated no relevant financial relationships. Shoma Bommena indicated no relevant financial relationships. Cameron Thompson indicated no relevant financial relationships. Sasha Taleban: AbbVie – Grant/Research Support. Boehringer-Ingelheim – Grant/Research Support. Eli Lilly – Grant/Research Support. Janssen – Advisory Committee/Board Member, Grant/Research Support. Pfizer – Grant/Research Support. Takeda – Grant/Research Support. Avin Aggarwal indicated no relevant financial relationships. Rolando Leal indicated no relevant financial relationships.
Akira Folk, DO1, Aarohi Deshmane, 2, Kirsten Pickard, MD1, Gregory Novak, MD1, Shoma Bommena, MBBS1, Cameron Thompson, MD1, Sasha Taleban, MD, FACG3, Avin Aggarwal, MD1, Rolando J. Leal, MD4. P1013 - Hidden in the Jejunum: A Case of Refractory Gastrointestinal Bleeding Due to Rare Jejunal Capillary Hemangioma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
