An Unusual Culprit: Rare Case of Duodenal Hemangioma in a Middle-Aged Man Presenting with Anemia

Abstract

Hemangiomas are benign vascular tumors that typically arise from the submucosal blood vessels. Duodenal hemangiomas, caused by abnormal vascular growth in the duodenal wall, are rare but can lead to severe, rapidly progressing GI bleeding requiring urgent intervention. Diagnosis usually involves endoscopic or surgical visualization, along with histological confirmation. These tumors make up less than 0.05% of all GI tumors and 7- 10% of small bowel neoplasms, making them an exceptionally rare cause of upper GI bleeding. Vascular lesions should be considered in the differential diagnosis of unexplained gastrointestinal bleeding. Gastrointestinal hemangiomatosis is associated with conditions such as Blue Rubber Bleb Nevus Syndrome, Proteus Syndrome, Maffucci’s Syndrome, Diffuse Neonatal Hemangiomatosis, and Klippel-Trénaunay-Weber Syndrome. It is characterized by diffuse infiltration of the intestinal wall, mesentery, and occasionally the retroperitoneum. Options for treatment include observation, sclerotherapy, and, in certain cases, open or laparoscopic surgery. Minimally invasive procedures like endoscopy - laser coagulation, endoscopic resection are preferred for diagnosing and treating duodenal hemangiomas in select patients.

We report a 40 year old man with upper abdominal pain, frequent vomiting, and intermittent melena for the past 5 - 6 months. After routine blood workup, patient was subjected for Upper GI endoscopy which revealed a 2 cm bluish swelling near the ampulla with intact mucosa and no active bleeding, consistent with duodenal hemangioma. MRCP identified it to be duodenal D2 hemangioma. This case highlights the need to consider duodenal hemangioma in upper GI bleeding and underscores the role of endoscopy in diagnosis and treatment, along with the potential need for surgery.