Cavernous Hemangioma of the Gastrointestinal Tract

cavernous hemangioma of the gastrointestinal tract is a rare lesion. Though it is frequently fatal, it is practically always curable. Its preoperative recognition is therefore of importance. Fortunately, many of these lesions present a recognizable roentgenologic appearance. Phleboliths have been reported in cavernous hemangioma of the stomach and colon and, when present, are highly suggestive of the diagnosis. Hansen, in 1948, wrote: “Phleboliths are said to be common and are often an important diagnostic point [in diffuse infiltrating cavernous hemangioma of the small bowel] but in no reported case of this type has the presence of phleboliths been mentioned.” Ochsner and Penick have also commented on this omission as recently as 1957. It is felt worthwhile, therefore, to report a case of jejunal hemangioma exhibiting numerous phleboliths in preoperative roentgen studies. The most widely accepted classification of gastrointestinal hemangiomas is that of Kaijser, as follows: I. Multiple phlebectasia II. Cavernous hemangioma A. Diffuse infiltrating B. Circumscribed, often polypoid III. Simple capillary hemangioma IV. Angiomatosis The second type, cavernous hemangioma, is the subject of this paper. The diffuse infiltrating form causes hemorrhage frequently and obstruction occasionally. Phleboliths are said to be common in this group and can be demonstrated roent-genologically. The small intestine, colon, and rectum are the most common sites of the lesion in the alimentary tract, but the stomach is sometimes involved, and even the esophagus and appendix may be affected. When obstruction occurs from this type, it is usually the result of intussusception. Phleboliths occur also in the circumscribed forms, but less commonly. The phleboliths may be homogeneous or layered. case report A 7-year-old girl was admitted to the Delaware Hospital on Jan. 25, 1952. Her mother stated that the child had been weak from birth and always seemed tired. These symptoms became worse several months before admission and were so severe that the child had to be carried about. She had always been pale. The history was otherwise unremarkable. Admission blood studies revealed a hemoglobin of 8.8 gm. and a red blood cell count of 2,900,000. The total white blood cell count was normal, but there was a marked eosinophilia. The hematocrit value was 34 per cent, and the reticulocyte count 5 per cent. Other blood findings were normal. Various roentgen studies, not including a small bowel series, were normal. The parents became dissatisfied and removed their daughter from the hospital against medical advice. For nearly three years thereafter she remained pale, weak, and tired. She was then readmitted because of periumbilical pain and vomiting. The vomitus was not bloody. The pain was dull and nonradiating, and its onset was followed usually by passage of a tarry stool. Laboratory studies again showed a severe anemia, and there was a strongly positive test for occult blood in the feces.