大量下血を繰り返した小腸粘膜下海綿状血管腫の一例

Abstract

We present a case of hemangioma of the small intestine with repeated massive bleeding. A 57-year-old woman repeated massive bleeding three times from February 1993 to July 1994. In the meantime endoscopic examination, enterography and abdominal angiography were performed and we detected an abnormal lesion in enterogra- phy. But we could not diagnose the cause of bleeding because the abnormal lesion was not recognised in angiography. At the third incidence of bleeding we performed an emergency operation. At the laparotomy a dark red, flat and soft tumor was found in the small intestine at 100 cm's distance from Treits ligament and a partial resection of jejunum was performed. By the microangiography of the resected speciemen and histological examina- tion, the tumor was diagnosed as a cavernous hemangioma of the small intestine. Tech- niques for efficient examination of the small intestine are not well established as compared to the other areas of the digestive tract. Therefore in this case we detected the abnormal lesion with enterography but we could not recognise any abnormal findings in angiography. As a result we were able to detect the hemangioma of the small intestine for the first time during the operation. The intestinal hemangioma is a rare case and it is difficult to diagnose the cause of bleeding as intestinal hemangioma without an abnormal finding in angiography. It is nesessary that we suspect that massive bleeding may be due to intestinal hemangioma when we cannot presume the origin of massive bleeding.