Small Bowel Bleeding Due to Venous Lake.

A 22-year-old woman presented with anemia and melena. No bleeding was observed on esophagogastroduodenoscopy or colonoscopy. Therefore, small bowel bleeding was considered. Peroral double-balloon enteroscopy revealed a 15-mm hemispherical submucosal tumor-like lesion in the upper jejunum with a 2-mm circular ulcer at the apex (Picture 1, 2). This lesion was classified as Yano-Yamamoto classification Type-4 and considered to be the source of the bleeding (1), and she underwent surgical excision. A histopathological examination revealed that the lesion was a dilated blood vessel without internal elastic lamina and had venous features, leading to the diagnosis of venous lake (Picture 3, 4). Venous lakes are structures consisting of dilated veins surrounded by a wall of fibrous tissue (2). Venous lakes are commonly found in the lips and auricles in elderly people but are rare in the gastrointestinal tract, with only one case reported previously (3). Venous lakes should be considered as a potential cause of small bowel bleeding.

Picture 1.

Picture 2.

Picture 3.

Picture 4.

The authors state that they have no Conflict of Interest (COI).