Pyogenic granuloma: an unusual cause of massive gastrointestinal bleeding from the small bowel

Abstract

Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal bleed, and reviews the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare gastrointestinal lesion.

Figure 1)

Jejunal pyogenic granuloma seen on push enteroscopy. The arrow indicates the distinctive white film coating

Figure 2)

Microscopy image of postsurgery pyogenic granuloma tissue showing dense vascular proliferation and inflammatory reaction in the stroma, consistent with pyogenic granulomas (hematoxylin and eosin stain, original magnification ×40)

Figure 3)

Immunohistochemical study in the same case shows negative staining for human herpes virus-8 (immunoperoxidase stain, original magnification ×40)

Figure 4)

Immunohistochemical staining for CD34 shows the endothelial cell population (immunoperoxidase stain, original magnification ×10). CD31 and factor VIII stains were also used to identify endothelial cells (data not shown)