It is generally believed that hemangioma is a congenital hamartomatous lesion that originates from embryonic sequestrations of mesodermal tissue [
1-
5]. Hemangioma is a benign tumor, which can be seen in many organs. Approximately 200 cases of gastrointestinal hemangiomas have been reported since 1839 but only a few of these have been reported to involve the mesentery and part of the gut [
1]. A classification system used by Abrahamson and Shandling divides intestinal hemangiomas into three categories on the basis of histologic appearances: capillary, cavernous, and mixed type [
6]. The most common type is the cavernous hemangioma [
6,
7]. Cavernous hemangiomas are macroscopically bluish purple, soft and compressible structures, arising from larger submucosal arteries and veins with varying lesion sizes.
Gastrointestinal hemangiomas arise from the submucosal vascular plexuses and may invade the muscularis layer. There is rarely penetration beyond the serosa [
10]. Gastrointestinal hemangiomas have been reported in patients ranging from 2 months to 79 years of age. No obvious sex predominance has been identified. They usually present in young men and women, often in the third decade of life [
1-
3].
The symptoms of hemangioma depends on the localization of the primary tumor. Eighty percent of patients with gastrointestinal hemangiomas presents with symptoms such as bleeding or obstruction [
7,
8]. The major symptom of gastrointestinal hemangiomas is bleeding [
7]. Whereas bleeding from capillary type lesions tends to be slow or may be occult, the hemorrhage in association with a cavernous hemangioma is usually of sudden onset and may present as either hematemesis or melena [
7,
8]. Our patient has had also recurrent lower gastrointestinal bleeding episodes in her history.
Hemangiomas may result in hemoperitoneum or intestinal obstruction due to the intussusception of the polypoid tumor. Whereas abdominal pain may become the major complaint in these patients, nausea, vomiting, and abdominal distention may also be found [
8-
11]. The type of treatment depends on the type of lesions, location, extent of involvement, extent of symptoms, and general operability [
10,
11].
Gastrointestinal hemangiomas of well-defined segment of intestinum are usually suitable for surgical resection at the time of diagnosis [
10,
11]. Recurrences after resection are rare [
10].
Low-dose radiation therapy, cryotheraphy, brachytheraphy, sclerotheraphy or arterial embolization has been used in nonresectable and diffuse hemangiomatosis with limited success [
12,
13].
Whereas preoperative definitive diagnosis of a mesenteric hemangioma is nearly impossible, oral and intravenous contrast enhanced computed tomography could be helpful in suspecting and localization of such a lesion. Surgical resection of the involved segment remains as the treatment of choice for suitable cases.
As a conclusion, mesenteric hemangioma may be the cause of recurrent lower gastrointestinal bleeding manifested with anemia, and/or episodes of abdominal pain. Although it is very rare, gastrointestinal hemangioma should be kept in mind after eliminating the more common causes of gastrointestinal hemorrhage in differential diagnosis.
1 Murat Ulas,1 Cem Ibis,1 Mutlu Unver,1 Nazan Ozsan,1 Funda Yilmaz,1 Galip Ersoz,1 Murat Zeytunlu,1 Murat Kilic,1 and Ahmet Coker1
