S4693 Hidden in the Jejunum: A Case of Refractory Gastrointestinal Bleeding Due to Rare Jejunal Capillary Hemangioma

Introduction: Small intestinal hemangiomas are rare congenital vascular tumors, accounting for 5-10% of all benign small bowel tumors. They usually present as chronic gastrointestinal bleeding, with the Jejunum being the most commonly affected site. Diagnosing these tumors can be challenging. Here, we report a rare case of jejunal capillary hemangioma that presented as a massive gastrointestinal bleed. Case Description/Methods: An 18-year-old man with no prior medical history presented to our institution with symptomatic iron-deficiency anemia with a hemoglobin of 10 g/dL (baseline of 14 g/dL) and 2 episodes of melena. The initial workup, which included a Meckel’s scan, esophagogastroduodenoscopy, and colonoscopy, was inconclusive. Due to ongoing hematochezia and persistent anemia requiring multiple blood transfusions, further evaluation with video capsule endoscopy (VCE) and computed tomography angiography was performed; however, these were non-diagnostic. A tagged RBC scan localized the bleeding to the small bowel. Double balloon enteroscopy (DBE) revealed a vascular appearing jejunal mass; 4 hemostatic clips were placed, and the site was tattooed. Despite temporary improvement, he was re-admitted 10 days later with a hemoglobin level of 5.7 g/dL. Due to worsening symptomatic anemia and concerns about malignancy, he underwent exploratory laparotomy with an intraoperative endoscopy that confirmed the previously identified jejunal lesion without evidence of synchronous lesions. Intraoperatively, a 2.3 × 1.8 × 1.2 cm palpable proximal jejunal mass and mesenteric lymphadenopathy were seen. The patient underwent a small bowel resection with primary jejunojejunostomy. Histopathology confirmed a vascular malformation consistent with intestinal capillary hemangioma with overlying mucosal ulceration. Seventeen regional lymph nodes were benign. Recovery was uncomplicated, and he was discharged in stable condition, with resolution of melena upon follow-up. Discussion: This case highlights the diagnostic and therapeutic challenges of small bowel capillary hemangioma, an uncommon cause of gastrointestinal bleeding, which was successfully treated with surgical resection. While advanced endoscopic techniques—including VCE, DBE, and push enteroscopy—can be helpful in locating the lesion and achieving hemostasis through endoscopic intervention, as in our case, histological examination of the surgically resected specimen is typically necessary for definitive diagnosis.