Pyogenic Granuloma of the Jejunum Causing Obscure Gastrointestinal Bleeding That Posed Difficulties in Diagnosis

Abstract

An 84-year-old man had visited his previous doctor complaining of black stools. Esophagogastroduodenoscopy revealed no significant source of bleeding, however, blood examination revealed severe anemia, and he was referred to our hospital. Total colonoscopy, contrast-enhanced computed tomography（CT）, and capsule endoscopy failed to reveal any significant lesions. The patient presented with recurrent bloody stools, and repeat CT identified an enhancing mass in the small intestine. Urgent enteroscopy failed to reveal the lesion, and emergency surgery was performed; postoperative histology revealed a pyogenic granuloma（PG）of the jejunum. PG, which is a polypoid lobular capillary hemangioma commonly involving the skin and oral cavity, rarely occurs in the gastrointestinal tract, to cause obscure gastrointestinal bleeding（OGIB）. PG could be difficult to detect, but can cause fatal anemia, so that it should be considered in the differential diagnosis in patients presenting with OGIB.