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Multiple Gastrointestinal Hemangiomatosis Successfully Treated With Propranolol

Akcam, Mustafa*; Pirgon, Ozgur; Salman, Hakan*; Kockar, Cem

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Journal of Pediatric Gastroenterology and Nutrition: March 2015 - Volume 60 - Issue 3 - p e16
doi: 10.1097/MPG.0b013e31829530af
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A 16-year-old boy presented with fatigue for 2 months and severe anemia (hemoglobin 4.9 g/dL). Physical examination was normal except pale skin, and no extraintestinal hemangiomatous lesion was found. Endoscopy revealed multiple cavernous hemangiomas in the stomach and colon (Fig. 1). Propranolol was started and gradually increased weekly to 2 mg−1 kg−1 d−1. The patient had no further complaints, and repeat endoscopic findings after 8 months showed significant decrease in size of the hemangiomas (Fig. 2). Recent discoveries concerning hemangioma pathogenesis provide both an improved understanding and more optimal approach to the evaluation and management of these patients (1). In 2008, propranolol was described as an effective treatment for infantile hemangiomas (2). Presently, propranolol is recommended as first-line treatment for infantile hemangiomas in many organs such as the liver (3). Oral propranolol gives providers a therapeutic option that may prevent or minimize medical risks of scarring, but the side-effect profile and risk–benefit of such interventions must be considered before instituting therapy (1). Our study indicates that propranolol is a well tolerated and effective therapy to potentially shrink gastrointestinal hemangiomas.

F1-1
FIGURE 1:
Hemangiomas were seen in endoscopical investigation at the admission; cardia (A), corpus (B), and descending colon (C).
F2-1
FIGURE 2:
Improved hemangiomas seen in endoscopical findings after 8 months; cardia (A), corpus (B), and colon (C–E).

REFERENCES

1. Chen TS, Eichenfield LF, Friedlander SF. Infantile hemangiomas: an update on pathogenesis and therapy. Pediatrics 2013; 131:99–108.
2. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358:2649–2651.
3. Bosemani T, Puttgen KB, Huisman TA, et al. Multifocal infantile hepatic hemangiomas-imaging strategy and response to treatment after propranolol and steroids including review of the literature. Eur J Pediatr 2012; 171:1023–1028.
© 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,