Obscure gastrointestinal bleeding: resection of a pyogenic granuloma of the ileum via double-balloon enteroscopy

Kenro Hirata, Naoki Hosoe, Hiroyuki Imaeda, Makoto Naganuma, Hiroko Murata, Mari Ueno, Hidekazu Suzuki, Haruhiko Ogata, Takanori Kanai

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)397-401
Number of pages5
JournalClinical journal of gastroenterology
Volume7
Issue number5
DOIs
Publication statusPublished - 2014 Oct 8

Keywords

  • Double-balloon enteroscopy
  • Estrogen
  • Ki-67
  • Progesterone
  • Pyogenic granuloma
  • VEGF

ASJC Scopus subject areas

  • Gastroenterology

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