Gastrointestinal Hemorrhage from a Small Bowel Polypoid Hemangioma

OBJECTIVES: Occult gastrointestinal bleeding can originate from the foregut, midgut, or hindgut. The evaluation of the foregut and hindgut are well established. Cases that involve bleeding from the midgut present a much more significant challenge in terms of detection and treatment. Methods of evaluation include small bowel endoscopy, arteriography, and gastrointestinal contrast studies. The differential diagnosis includes arteriovenous malformations, angiodysplasia, ulcers, and small bowel tumors. We will demonstrate that both the evaluation and treatment of these lesions may be accomplished using minimally invasive techniques. METHODS: A case of occult gastrointestinal bleeding from a polypoid hemangioma located in the distal jejunum is presented. Diagnosis and treatment was accomplished using angiographic localization with laparoscopic resection. RESULTS: Laparoscopic small bowel resection after angiographic localization was successful in removing the jejunal polypoid hemangioma. The patient experienced no further gastrointestinal bleeding. CONCLUSIONS: We will discuss the technique of localization and treatment used in this unusual case. A laparoscopic approach is an appropriate and beneficial treatment modality in a bleeding midgut lesion provided the lesion can be localized preoperatively and an oncologic resection is maintained.