title: Small intestine bleeding due to multifocal angiosarcoma.
abstract: We report a case of an 84-year-old male patient with primary small intestinal angiosarcoma. The patient initially presented with anemia and melena. Consecutive endoscopy revealed no signs of upper or lower active gastrointestinal bleeding. The patient had been diagnosed 3 years previously with an aortic dilation, which was treated with a stent. Computed tomography suggested an aorto-intestinal fistula as the cause of the intestinal bleeding, leading to operative stent explantation and aortic replacement. However, an aorto-intestinal fistula was not found, and the intestinal bleeding did not arrest postoperatively. The constant need for blood transfusions made an exploratory laparotomy imperative, which showed multiple bleeding sites, predominately in the jejunal wall. A distal loop jejunostomy was conducted to contain the small intestinal bleeding and a segmental resection for histological evaluation was performed. The histological analysis revealed a less-differentiated tumor with characteristic CD31, cytokeratin, and vimentin expression, which led to the diagnosis of small intestinal angiosarcoma. Consequently, the infiltrated part of the jejunum was successfully resected in a subsequent operation, and adjuvant chemotherapy with paclitaxel was planned. Angiosarcoma of the small intestine is an extremely rare malignant neoplasm that presents with bleeding and high mortality. Early diagnosis and treatment are essential to improve outcome. A small intestinal angiosarcoma is a challenging diagnosis to make because of its rarity, nonspecific symptoms of altered intestinal function, nonspecific abdominal pain, severe melena, and acute abdominal signs. Therefore, a quick clinical and histological diagnosis and decisive measures including surgery and adjuvant chemotherapy should be the aim.
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University, Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
authors.forename: Luisa
authors.initials: L
authors.lastname: Zacarias Föhrding
authors.forename: Arne
authors.initials: A
authors.lastname: Macher
authors.forename: Stefan
authors.initials: S
authors.lastname: Braunstein
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
authors.forename: Stefan Andreas
authors.initials: SA
authors.lastname: Topp
mesh_terms: D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D001803:Blood Transfusion; D017024:Chemotherapy, Adjuvant; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006394:Hemangiosarcoma / Q000737:chemistry / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D007580:Jejunal Neoplasms / Q000737:chemistry / Q000150:complications* / Q000473:pathology / Q000601:surgery; D007582:Jejunostomy; D008297:Male; D008551:Melena / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor