Cavernous Hemangiomata O F Small and Large Bowel

Benign tumors of the intestinal tract are rare, and vascular tumors are even rarer. In 1898, Longuet (1) cited 3 cases. In a review of the literalure in 1924 Brown (2) found 20 cases of vascular tumors below the stomach. McClure and Ellis (3) in 1930 reported 25 cases. The tumors are more often single than multiple. Of Brown's 20 cases, 12 were single and 8 were multiple. Of the 25 cases of McClure and Ellis, 14 were single and 11 were multiple. Involvement of the entire gastro-intestinal tract is rare. Winternitz and Boggs (4) reported such a case of multiple hemangiomata, some of which were undergoing malignant degeneration. These hemangiomata have been classified into four groups by Brown: ( a ) multiple tumors of the vascular arcades arising either in a vein or artery, and microscopically either capillary or cavernous hemangiomata; ( b ) those arising in the submucosa, growing towards the lumen with possible ulceration and hemorrhage; (c) those arising in the submucosa which grow to a large size and which may cause obstruction; (d) diffuse ring-like tumors beginning in the submucosa, involving the muscularis, and constricting the lumen of the gut, producing acute or chronic intestinal obstruction. They may occur at any age, being reported as early as two months and as late as seventy-nine years, and may be located anywhere from the mouth to the anus. These tumors are brought to the attention of the patient by symptoms of obstruction, either acute or chronic, or by signs of hemorrhage. About half of them give no symptoms. In this latter group diagnosis is not usually made, though certain conditions may lead to their discovery. There may, for example, be other hemangiomata of the skin, tongue, or mucous membrane which are visible. In other instances obscure hemorrhage may occur for which no other etiological agent can be suggested. Finally the lesions may be detected radiographically. Judd and Rankin (5) have described the radiological changes in conjunction with hemangiomata of stomach and duodenum. They are not, however, distinguishable from those of cancer and as the patients are often elderly, the diagnosis of cancer, is, of course, regarded as the more probable one. With radiological changes in portions of the gastro-intestinal tract such as the duodenum, a benign tumor rather than a malignant tumor may be suspected. Hemangiomata may bleed within the gastro-intestinal tract and in some instances may cause death from massive hemorrhage. Laboulbhe (6) reported a case with death from hemorrhage from hemangioma in the duodenum. Paci ( 7 ) described a case in which a cavernous hemangioma was torn loose in the bowel during violent purging and was passed with a large amount of blood.