At the focal point

Pyogenic granuloma of the small intestine

Pyogenic granuloma (PG), also called lobular capillary hemangioma, is a benign vascular proliferation in skin or oral mucosa after local trauma or irritation. PG is rarely reported in the gastrointestinal (GI) tract.

A sixty-three-year-old woman presented with recurrrent melena and anemia. 1 cm Erythematous semi-pedunculated polypoid lesion was seen on the ampulla of Vater. The mucosal patterns were not suggestive of adenoma or that of an invasive lesion. The polypoid lesion was completely removed en bloc using an endoscopic snare with coagulation current. Immediate post-polypectomy pulsatile bleeding developed and hemostasis was achieved with endoclip application without pre-injection.

Pathology showed ampullary PG. To date, the patient has not developed further GI bleeding and her anemia resolved.

To the best of our knowledge, this is the first reported case of ampullary PG. In the medical literature, less than two dozen cases of PG are reported in the esophagus, stomach, small bowel, and colon. These patients usually present with gross or occult GI bleeding and anemia. GI PG can be curatively treated with endoscopic polypectomy or surgical resection.

In children, pyogenic granulomas are most commonly cutaneous benign vascular lesions but can also present in the gastrointestinal tract. When they occur in the intestine, they can cause acute or chronic gastrointestinal bleeding. We present an unusual case of rectal pyogenic granuloma and our management strategy.