S6013 Pyogenic Granuloma at the Ileocecal Junction: Unusual Culprit of Chronic Anemia and Intussusception

Introduction: Pyogenic granulomas (PGs), or lobular capillary hemangiomas, are benign vascular lesions commonly found on the skin and oral mucosa. Gastrointestinal involvement is exceedingly rare but clinically significant when present. In the small intestine, PGs can cause chronic bleeding, iron deficiency anemia, or serve as lead points for intussusception. Diagnosis is challenging due to their small size, vascularity, and frequent location beyond the reach of conventional endoscopy. Awareness of these atypical presentations is essential to ensure timely recognition and management. Case Description/Methods: A 78-year-old woman with hypertension, asthma, gastroesophageal reflux disease, and chronic anemia presented with acute abdominal pain, nausea, and vomiting. Computed tomography revealed a target sign suggesting ileocecal intussusception and a 2 cm nodular mass near the cecum. Prior colonoscopy and esophagogastroduodenoscopy were negative. She underwent partial right colectomy and extended ileectomy. Pathology identified a large obstructing pyogenic granuloma. Her postoperative course included transfusion and a readmission for deep vein thrombosis and pulmonary embolism while anticoagulation was held. Hemoglobin stabilized with iron therapy, and she remains under hematology care. Discussion: While PGs are typically small and frequently missed on imaging or endoscopy, they may grow large enough to cause obstruction or act as a lead point for intussusception, as seen in this case. The etiology is unclear but may involve mucosal irritation or inflammation. This patient had recently completed H. pylori treatment, which has been associated with microbiome and immune changes in the ileocecal region. Early consideration of vascular lesions in cases of unexplained GI bleeding or obstruction may help avoid delayed diagnosis and improve outcomes.