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An uncommon cause for obscure gastrointestinal bleeding
Edgar Afecto, Adelia Rodrigues, Ana Ponte, Joao Carlos Silva, Catarina Gomes, Rolando Pinho, Sonia Fernandes, Joao Carvalho
Centro Hospitalar de Vila Nova de Gaia e Espinho
Male, 85 years old with past history of hypertension, atrial fibrillation and stroke, medicated with apixaban and perindopril. He was admitted to our center with melena and haemoglobin of 7.6g/dL. An upper endoscopy and colonoscopy were performed, both normal. A capsule endoscopy followed, which identified innumerable blueish lesions, 8-30mm of size, some of which with hematocysts, compatible with hemangiomas, surrounded by normal appearing mucosa. Fresh blood was also identified in the proximal ileum. A diagnosis of blue rubber-bleb nevus syndrome was made and the patient was managed conservatively. At 1 month follow-up, he is asymptomatic, with no further blood losses.
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