Cavernous Gastric Hemangioma as an Unusual Cause of Upper Gastrointestinal Bleeding in a Young Woman

Abstract

Gastric hemangiomas (GHs) are extremely rare vascular lesions of mesodermal origin that may occur in isolation or in conjunction with underlying congenital pathology. Due to the scarcity of these tumors, there is no standardized diagnostic method; however, many have found the combination of endoscopic investigation and radiographic imaging to be most effective, with the presence of phleboliths on computerized tomography as being pathognomonic for GHs. Surgical treatment for symptomatic lesions is curative with no reports of recurrence. We describe a 21-year-old woman who presented with epigastric pain and one episode of 250 mL hematemesis earlier that morning. Under the impression of an upper gastrointestinal bleed due to peptic ulcer disease, esophagogastroduodenoscopy was performed which revealed a 5-cm blood clot-like mass similar in appearance to that of a II-b peptic ulcer, but the presence of a bridging fold led to the suspicion of a possible submucosal tumor. Dynamic computerized tomography scan showed similar findings, and the patient was referred for surgical intervention. Laparoscopic distal gastrectomy was performed with the final diagnosis of cavernous GH made via histological evaluation. The patient was discharged 9 days later with no complications. This case puts emphasis on the importance of considering cavernous GH as a potential cause of severe upper GI bleeding especially in those with atypical demographic profile and history.

A rare case of gastrointestinal bleeding caused by gastric capillary hemangioma

“…Gastric hemangiomas do not possess the hallmark features of tumors and are essentially vascular malformations rather than true neoplasms. Histologically, gastric hemangiomas can be categorized into three types: cavernous hemangioma, capillary hemangioma, and mixed hemangioma, with cavernous hemangioma being the most frequently observed subtype [ 4 ]. In the present case, the pathological diagnosis was gastric capillary hemangioma, which is less prevalent than the other two subtypes.…”

“…Previous reports have predominantly employed surgical intervention as the primary treatment method for adult patients, with no recurrence after complete hemangioma resection and active drug treatment [ 2 , 7 ]. Depending on the size, location, and preference of the surgeon, wedge resection, subtotal gastrectomy, or total gastrectomy are all viable surgical options [ 4 ]. For submucosal lesions of <2 cm in diameter, ESD may be performed after appropriate preoperative evaluation [ 8 ].…”