A 22-year-old woman with recurrent gastrointestinal bleeding since childhood

A 22-year-old woman was referred to our unit for capsule endoscopy because of recurrent iron deficiency anaemia and gastrointestinal bleeding since childhood. Cutaneous vascular lesions had been surgically removed when she was a child. During the preceding year she required blood transfusions every month and had a total of 9 iron infusions. Gastroscopy and colonoscopy at another hospital had shown small vascular lesions in the stomach, duodenum and colon. Clinical examination revealed pallor. Blood investigations showed a haemoglobin level of 9.6 g/dl and a MCV of 67 fl. The capsule endoscopy (PillCam, Given Imaging) was performed. Fifteen lesions similar to those shown in figures 1 and 2 were noted through-out the small bowel. She underwent a laparotomy with intra-operative entero-scopy; the lesions were removed and the histology is shown in figure 3.