Venous malformations as a rare cause of lower gastrointestinal bleeding in a young patient with Blue Rubber Bleb Nevus Syndrome

We report a case of 19-year-old male who presented with complaints of recurrent episodes of passage of black coloured stools since last 2 weeks. The patient reported that he had multiple blue coloured lesions in hands, legs and face since childhood. At physical examination, the lesions were of variable sizes ranging from 3-10 mm and resembled small bubbles of blue colouration. Biopsy taken from one of the lesions in childhood was suggestive of cavernous haemangioma. Laboratory investigations revealed microcytic anaemia (haemoglobin 9 g/dL; serum ferritin 22ng/ ml; transferrin saturation 10%) with normal rest of the laboratory parameters. His stool sample tested positive for occult blood. Further colonoscopy done to look for the origin of bleed revealed multiple, variable sized vascular malformations involving the colon and visualized distal 10 cm of terminal ileum without any active bleed. Gastroscopy revealed multiple vascular malformations in the stomach and second part of duodenum.