AN UNUSUAL CAUSE OF ACUTE LOWER GASTROINTESTINAL BLEEDING
Case Report: A 36-year-old presented with abdominal cramps, diarrhoea and several episodes of profuse rectal bleeding (1 week duration). No associated fever sweats or weight loss. He was haemodynamically stable. He had mild left iliac fossa tenderness, no organomegaly and bowel sounds were normal. Digital rectal examination revealed some fresh blood but no haemorrhoids and a normal prostrate. Other systems were unremarkable. Investigations: c-RP 10 mg/l, Hb 13.5 g/dl, WBC 8.34×103/mm3, and platelets 162×103/mm3. Multiple stool cultures were negative. A flexible sigmoidoscopy demonstrated blue lesions in the recto-sigmoid area, confluent inflammation of the descending and sigmoid colon, and relative rectal sparing, with ulceration. The histopathology specimens revealed ischaemic colitis with red cell extravasation, haemosiderin deposition and fibrosis. Mesalazine was discontinued. The patient had no further rectal bleeding and remained asymptomatic during his follow up over 6 months. This is first reported association of ischaemic colitis with Blue Rubber Bleb Nevus (BRBS) syndrome. BRBN are cavernous haemangioma lined by single layer of endothelium surrounded by thin connective tissue.1 The fragility of thin wall may predispose to further bleeding into submucosa compromise the vascular supply. BRBNS is managed conservatively with iron replacement therapy and transfusions. Endoscopic laser photocoagulation, systemic treatment with corticosteroids, interferon and vincristine may also be effective.2 Subcutaneous octreotide in the presence of active lesion proliferation or DIC has been used successfully.3,4 Skin lesions have been treated with the neodymium: YAG laser.5
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