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Pyogenic granuloma of the ileum depicted by small-bowel radiography, capsule endoscopy and double balloon endoscopy
Digestive and Liver Disease 47 (2015) 436
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Pyogenic granuloma of the ileum depicted by small-bowel radiography, capsule endoscopy and double balloon endoscopy Keisuke Kawasaki a,∗ , Koichi Kurahara b , Takayuki Matsumoto a a b
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan
An 86-year-old woman was admitted because of occult obscure gastrointestinal bleeding (OGIB). Capsule endoscopy (CE) showed a polypoid lesion in the middle small bowel (Fig. 1A). Doublecontrast small bowel radiography revealed a semi-pedunculated polypoid lesion in the ileum, measuring 7 mm in size (Fig. 1B). Based on the radiographic findings, retrograde double balloon endoscopy (DBE) was performed. The lesion was reddish in colour, and the surface was covered with whitish exudates and slight oozing (Fig. 2A). The lesion was removed by endoscopic mucosal resection. Histological examination showed that the tumour was composed of proliferation of capillary-sized vessels with mucosal
erosion (Fig. 2B). These findings were compatible with a diagnosis of pyogenic granuloma (PG). Although PG of the small bowel has been rarely reported, patients with the tumour manifest overt OGIB [1]. Radiography can easily overlook PG because of its small size [1]. While CE is a promising procedure, it is not optimal for the exact localisation of the lesion. In contrast, PG was accurately depicted by small bowel radiography in our case, thereby resulting in an appropriate choice for the route of DBE. Our case suggests that radiography may still be complementary for the diagnosis and the treatment of small-sized tumours of the small bowel, such as PG.
Fig. 1.
Fig. 2.
Reference ∗ Corresponding author at: Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Uchimaru 19-1, Morioka City, Iwate 020-8505, Japan. Tel.: +81 19 651 5111; fax: +81 19 907 4327. E-mail address: [email protected] (K. Kawasaki).
[1] Chou JW, Lai HC, Lin YC. Image of the month. Pyogenic granuloma of the small bowel diagnosed by capsule endoscopy and double-balloon enteroscopy. Clinical Gastroenterology and Hepatology 2009;7:A26.
http://dx.doi.org/10.1016/j.dld.2014.11.014 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Pyogenic granuloma of the ileum depicted by small-bowel radiography, capsule endoscopy and double balloon endoscopy Keisuke Kawasaki a,∗ , Koichi Kurahara b , Takayuki Matsumoto a a b
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan
An 86-year-old woman was admitted because of occult obscure gastrointestinal bleeding (OGIB). Capsule endoscopy (CE) showed a polypoid lesion in the middle small bowel (Fig. 1A). Doublecontrast small bowel radiography revealed a semi-pedunculated polypoid lesion in the ileum, measuring 7 mm in size (Fig. 1B). Based on the radiographic findings, retrograde double balloon endoscopy (DBE) was performed. The lesion was reddish in colour, and the surface was covered with whitish exudates and slight oozing (Fig. 2A). The lesion was removed by endoscopic mucosal resection. Histological examination showed that the tumour was composed of proliferation of capillary-sized vessels with mucosal
erosion (Fig. 2B). These findings were compatible with a diagnosis of pyogenic granuloma (PG). Although PG of the small bowel has been rarely reported, patients with the tumour manifest overt OGIB [1]. Radiography can easily overlook PG because of its small size [1]. While CE is a promising procedure, it is not optimal for the exact localisation of the lesion. In contrast, PG was accurately depicted by small bowel radiography in our case, thereby resulting in an appropriate choice for the route of DBE. Our case suggests that radiography may still be complementary for the diagnosis and the treatment of small-sized tumours of the small bowel, such as PG.
Fig. 1.
Fig. 2.
Reference ∗ Corresponding author at: Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Uchimaru 19-1, Morioka City, Iwate 020-8505, Japan. Tel.: +81 19 651 5111; fax: +81 19 907 4327. E-mail address: [email protected] (K. Kawasaki).
[1] Chou JW, Lai HC, Lin YC. Image of the month. Pyogenic granuloma of the small bowel diagnosed by capsule endoscopy and double-balloon enteroscopy. Clinical Gastroenterology and Hepatology 2009;7:A26.
http://dx.doi.org/10.1016/j.dld.2014.11.014 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.