Gastric Hemangioma Treated with Argon Plasma Coagulation in a Newborn Infant

Abstract

Gastric hemangioma in the neonatal period is a very rare cause of upper gastrointestinal bleeding. We present a case of hemangioma limited to the gastric cavity in a 10-day-old infant. A huge, erythematous mass with bleeding was observed on the lesser curvature side of the upper part of the stomach. Surgical resection was ruled out because the location of the lesion was too close to the gastroesophageal junction. Medical treatment with intravenous H2 blockers, octreotide, packed red blood cell infusions, local epinephrine injection at the lesion site, application of hemoclip, and gel-form embolization of the left gastric artery did not significantly alter the transfusion requirement. Hemostasis was achieved with endoscopic argon plasma coagulation (APC). After two sessions of APC, complete removal of the lesion was achieved. APC was a simple, safe and effective tool for hemostasis and the ablation of gastric hemangioma without significant complications.

A Newborn with Gastric Hemangioma Treated Using Propranolol

“…Gastric hemangiomas, that occur more rarely, are frequently observed as isolated lesions. So far, 22 cases of gastric hemangioma have been reported in pediatric patients; of these, 13 were isolated cases [ 1 2 3 4 ]. Four cases of hemangiomas were reported in the neonatal period, three of which were reported as isolated gastric hemangioma [ 2 4 5 10 ].…”

“…In addition, vincristine, interferon 1 alpha and other antiangiogenic drugs may be used [ 2 9 ]. For patients not responding to medical treatment, argon plasma coagulation, laser photocoagulation, sclerotherapy, band ligation or surgical resection are other treatment options [ 4 8 16 ]. In a case series of 16 patients with gastrointestinal hemangioma, 8 diagnosed in neonatal period, 14 received pharmacological treatment.…”

“…There was no GIS bleeding and in control endoscopic examination performed three weeks later, the lesion had regressed and medical treatment continued. In a previous study of 22 gastric hemangioma cases reported in childhood, surgical intervention was performed in all cases except four [ 1 2 3 4 ]. Presently, oral propranolol may be considered as first-line treatment in infantile hemangiomas [ 18 ].…”

“…GIS hemangiomas in the stomach are rare. So far, 22 cases of gastric hemangioma have been reported in pediatric patients; of these, 13 were isolated cases [ 1 2 3 4 ]. Esophagogastroduodenoscopy, angiography and computed tomography are valuable in diagnosis of gastric hemangiomas.…”

“…Propranolol is commonly used with corticosteroids to treat non-gastric GIS hemangiomas [ 7 ]. However, pharmacotherapy has often been performed in a small number of hemangioma patients with multiple lesions in the GIS, wherein surgical possibilities are limited [ 2 3 4 8 ]. We report the case of a neonate with an isolated gastric hemangioma, presented with massive gastrointestinal bleeding, and the hemangioma shrunk with propranolol therapy after bleeding was controlled with antisecretory drugs.…”