WOFAPS 2025 8th World Congress of Pediatric Surgery

Maria Manousi, Maria Yvelise De Verney, Panayiota Kafritsa, Maria Klavdianou, Christos Salakos

IASO Children's Hospital, Athens, Greece

Introduction

Gastrointestinal infantile hemangioma is an extremely rare cause of rectal bleeding. A positive GLUT1 immunostain on biopsy is diagnostic, distinguishing it from other vascular anomalies. Propranolol is the first-line treatment, while surgery is reserved for cases unresponsive to medical therapy.

Case report

A female neonate, born at 32+6 weeks via cesarean section for placenta previa at our institution, developed significant rectal bleeding on day 18, necessitating RBC transfusions. A Meckel’s scan was negative, and both abdominal ultrasound and radiographic evaluations revealed no abnormalities. Gastroscopy showed no evidence of upper gastrointestinal bleeding.

By day 21, an exploratory laparotomy identified diffuse lesions over a 35 cm segment of the small intestine. A 3-cm portion was resected for biopsy, and empirical propranolol therapy was initiated. Bleeding recurred on day 24, prompting a second laparotomy and intraoperative enteroscopy, which confirmed the extent of the lesions and their response to propranolol. Based on these findings, propranolol was continued without additional resection.

On day 31, following a brief period of feeding tolerance, further bleeding necessitated resection of a 36-cm segment of affected small bowel. The colon appeared macroscopically normal, so colonoscopy was not performed.

The infant was discharged on day 46 while receiving propranolol, feeding well, and passing normal stools. Propranolol was discontinued at three months of age, and the child has remained asymptomatic with normal growth to date. Notably, imaging revealed no cutaneous, hepatic, or cerebral hemangiomas.

Conclusion

Small intestinal hemangiomas should be considered in neonates with rectal bleeding, even in the absence of skin or visceral lesions. Diagnosis is challenging in preterm infants due to limited imaging sensitivity. Intraoperative enteroscopy is valuable for assessing lesion extent and therapeutic response. In cases unresponsive to medical management, segmental resection is necessary, with an emphasis on preserving bowel length to prevent short bowel syndrome.