Vascular malformation of small bowel causing iron deficiency anemia in a child: case report

Introduction

Vascular malformations of the small bowel in children are extremely rare and often present with nonspecific symptoms.

Case presentation

A 7-year-old male presented with one year of progressive easy fatigability and a single episode of bright red rectal bleeding. Laboratory evaluation showed microcytic hypochromic anemia with a hemoglobin value of 6.5 g/dL, requiring a transfusion of packed red blood cells. The rectal exam was normal. Imaging studies, including abdominal ultrasound, CT scan, and magnetic resonance angiography, identified a 5× 7 x 3-cm lobulated, low-flow vascular malformation in the small bowel. The patient was taken to the operating room for an exploratory laparotomy, which was done through a midline incision. We found a 5 x 6-cm vascular malformation on a jejunal loop, 40 cm distal to the ligament of Treitz. The malformation appeared to involve the entire circumference of the affected jejunal segment. We resected the jejunal segment that contained the vascular malformation including 1 extra cm of healthy-appearing jejunum on each side, and did an end-to-end anastomosis. The postoperative recovery was uneventful. Enteral feedings were started on the second postoperative day, and he was discharged home on the fourth postoperative day. The histopathological analysis was consistent with a vascular malformation with dilated blood vessels. At one-month follow-up he showed resolution of the anemia and had no recurrence of symptoms.

Conclusion

Vascular malformations can involve the small bowel and be the source of occult or obvious gastrointestinal bleeding. They should be considered in the differential diagnosis of children who develop iron deficiency anemia of unknown etiology.