title: Obscure gastrointestinal bleeding: resection of a pyogenic granuloma of the ileum via double-balloon enteroscopy.
abstract: Pyogenic granulomas usually occur on the skin or oral mucosa; however, they rarely develop in the gastrointestinal tract, particularly in the ileum. We report the case of an 82-year-old female who experienced occasional bloody stools. Initially, no significant bleeding source could be identified via conventional endoscopy; however, repeat capsule endoscopy identified a bleeding polyp (8 mm) in the ileum. Therefore, we resected the polyp via double-balloon enteroscopy. Histopathological findings showed increased, lobulated, and enlarged capillaries and desquamated epithelium indicative of epithelial erosion. In addition, neutrophil-predominant inflammatory cell infiltrate and interstitial edema were observed in the intercapillary stroma. Immunohistochemical analysis showed positive staining for vascular endothelial cell markers. Previous reports have mentioned that pyogenic granulomas in the oral cavity were associated with the female hormonal receptor, vascular endothelial growth factor, and proliferative immune markers; however, no significant staining was observed in our patient. This is the first report discussing an association between pyogenic granulomas and these markers. Pyogenic granulomas in the ileum are rare and may cause fatal anemia. Pyogenic granulomas should be considered in the differential diagnosis of obscure gastrointestinal bleeding.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi Shinjuku, Tokyo, 160-8582, Japan.
authors.forename: Kenro
authors.initials: K
authors.lastname: Hirata
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosoe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Imaeda
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.forename: Hiroko
authors.initials: H
authors.lastname: Murata
authors.forename: Mari
authors.initials: M
authors.lastname: Ueno
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D000369:Aged, 80 and over; D058582:Double-Balloon Enteroscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D017789:Granuloma, Pyogenic / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007077:Ileal Diseases / Q000150:complications* / Q000601:surgery*; D012074:Remission Induction