Obscure-occult bleeding: resolution of unexplained chronic sideropenic anaemia by colonoscopic removal of a colonic leiomyoma

Abstract

BACKGROUNDSmooth muscle tumours of the gastrointestinal tract are uncommon, but those arising in the colon and rectum are rare and represent only 3% of all alimentary tract leiomyomas. 1 Several cases of endoscopic resection of colonic leiomyomas have been described. 2 3 Because conventional polypectomy of leiomyomas can result in perforation, the technique of submucosal injection polypectomy can be used to reduce the risk of this complication. We report a case of a woman affected by sigmoid leiomyoma in which complete enucleation was performed at the time of colonoscopy using this method.

Cecal Leiomyoma: Can We Attempt Endoscopic Resection?

“…Large leiomyomas are also known to cause compressive and obstructive symptoms based on location. Bleeding from leiomyoma can vary from being detected on occult blood testing [8, 9] to more overt bleeding. Massive blood loss needing transfusion, perforation, obstruction, intussusception [10] and hemoperitoneum [11] are among the few complications described which generally require surgical intervention.…”

“…Endoscopic snare cauterization with or without saline lift has been described in literature especially for tumors involving the left colon [9, 12]. This partly could parallel the higher incidence of these tumors in left colon.…”

Clinical Outcomes of Endoscopic Removal in Patients with Colorectal Polypoid Leiomyomas

“…4,[11][12][13] Rarely, small leiomyomas less than 1 cm were reported to cause iron deficiency anemia, which was corrected after endoscopic resection. 10 Most polypoid leiomyomas of the colon and rectum presented endoscopically as small sessile polyps, with the exception of five pedunculated polyps. Although leiomyomas usually appear as a glistening, smooth, round sessile polyp on colonoscopy, they are occasionally indistinguishable from hyperplastic or adenomatous polyps.…”

“…3 However, several case reports have shown that endoscopic resection of small polypoid leimyomas is feasible. 2,[4][5][6][7][8][9][10][11][12][13] Since screening colonoscopy for colorectal cancers became widely available, the detection of small polypoid leiomyomas by colonoscopy has increased. 14 In the present study, we evaluated clinicopatho-logical characteristics of colorectal polypoid leiomyomas and the efficacy and outcome of endoscopic removal of these lesions.…”