Buscar en
Gastroenterología y Hepatología (English Edition)
Toda la web
Inicio Gastroenterología y Hepatología (English Edition) Capsule endoscopy: Diagnosis of lobular capillary haemangioma
Journal Information
Vol. 40. Issue 6.
Pages 403-404 (June - July 2017)
Vol. 40. Issue 6.
Pages 403-404 (June - July 2017)
Scientific letter
DOI: 10.1016/j.gastre.2017.05.004
Full text access
Capsule endoscopy: Diagnosis of lobular capillary haemangioma
Cápsula endoscópica: diagnóstico de hemangioma capilar lobulillar
Marta Magaz Martínez
Corresponding author

Corresponding author.
, José Luis Martínez Porras, César Barrios, Luis Abreu
Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
Article information
Full Text
Download PDF
Figures (1)
Full Text

Lobular capillary haemangioma (also called pyogenic granuloma) is a benign vascular lesion of the skin or mucous membranes characterised by rapid growth and a friable surface.1,2 Involvement of the skin is much more common than involvement of the mucosa, where the predominant sites are the gums and the oral cavity.3 Its development in the gastrointestinal tract is very rare.4 We present the case of a 52-year-old woman with no relevant history who was referred from outpatient care, due to a haemoglobin level of 4.5g/dl, and admitted. Her only symptoms were asthenia and a single episode of haematochezia.

A gastroscopy was performed and detected only a mucosa with patchy erythema in the antrum and body, with no other associated lesions. An ileocolonoscopy showed isolated diverticular orifices in the sigmoid colon, with no evidence of bleeding. Subsequently, a capsule endoscopy was performed and showed a raised formation with a polypoid appearance in the jejunum and eroded mucosa at the apex of its surface, 1cm in size (Fig. 1). As it could have been related to the patient's signs and symptoms, it was decided to resect the small bowel segment described and perform a latero-lateral surgical anastomosis. The results of the histology study revealed a polypoid haemangioma (lobular capillary haemangioma) in the mucosa, superficially ulcerated with signs of bleeding, with no signs of malignancy.

Figure 1.

Capsule endoscopy image: vascular lesion consistent with lobular capillary haemangioma.


The most common indication for capsule endoscopy is an assessment of suspected bleeding from the small bowel, including iron-deficiency anaemia and haemorrhage of unclear origin. However, even with the use of capsule endoscopy, it may be difficult to identify the cause of bleeding in the small bowel. Vascular abnormalities may end up being found in the gastrointestinal tract.5,6 Some lesions are present from birth or as part of syndromes; however, most are acquired throughout life.

The aetiopathogenesis of lobular capillary haemangioma is unknown. Although it may occur at any age, it is more common in children and young adults in their teens and twenties.2 In the case presented, the patient happened to be older. The surface of this lesion may ulcerate and bleeds very easily. In fact, in terms of signs and symptoms, when there is gastrointestinal involvement, patients range from being asymptomatic to presenting with macroscopic bleeding, anaemia or even dysphagia.5 Capsule endoscopy may be very helpful in its diagnosis, although its final diagnosis is histological; this lesion consists of a proliferation of capillaries with stromal oedema and mixed inflammatory infiltrate.7 Although endoscopic polypectomy, embolisation and treatment with a laser have been reported, surgical treatment may be required,8,9 as bleeding is often repeated and profuse, and surgery prevents recurrences.


This article does not have any funding.

Conflicts of interest

The authors declare that they have no conflicts of interest.

S.E. Mills, P.H. Cooper, R.E. Fechner.
Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. A study of 73 cases from the oral and nasal mucous membranes.
Am J Surg Pathol, 4 (1980), pp. 470
A.V. Giblin, A.J. Clover, A. Athanassopoulos, P.G. Budny.
Pyogenic granuloma – the quest for optimum treatment: audit of treatment of 408 cases.
J Plast Reconstr Aesthet Surg, 60 (2007), pp. 1030
M.N. Harris, R. Desai, T.Y. Chuang, A.F. Hood, G.W. Mirowski.
Lobular capillary hemangiomas: an epidemiologic report, with emphasis on cutaneous lesions.
J Am Acad Dermatol, 42 (2000), pp. 1012
D.C. Moffatt, P. Warwryko, H. Singh.
Pyogenic granuloma: an unusual cause of massive gastrointestinal bleeding from the small bowel.
Can J Gastroenterol, 23 (2009), pp. 261
M. Pennazio, C. Spada, R. Eliakim, M. Keuchel, A. May, C.J. Mulder, et al.
Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of smallbowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
V. Pons Beltrán.
Obscure gastrointestinal bleeding and obscure capsule. May we switch on any lights?.
Rev Esp Enferm Dig, 107 (2015), pp. 711-713
I. Kuzu, R. Bicknell, A.L. Harris, M. Jones, K.C. Gatter, D.Y. Mason.
Heterogeneity of vascular endothelial cells with relevance to diagnosis of vascular tumours.
J Clin Pathol, 45 (1992), pp. 143
A. Kusakabe, H. Kato, K. Hayashi, T. Igami, H. Hasegawa, T. Tsuzuki.
Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.
J Gastroenterol, 40 (2005), pp. 530-535
K. Hirakawa, K. Aoyagi, T. Yao, K. Hizawa, H. Kido, M. Fujishima.
A case of pyogenic granuloma in the duodenum: successful treatment by endoscopic snare polypectomy.
Gastrointest Endosc, 47 (1998), pp. 538-540

Please cite this article as: Magaz Martínez M, Martínez Porras JL, Barrios C, Abreu L. Cápsula endoscópica: diagnóstico de hemangioma capilar lobulillar. Gastroenterol Hepatol. 2017;40:403–404.

Copyright © 2016. Elsevier España, S.L.U., AEEH and AEG
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos