A Rare Cause of Chronic Iron Deficiency Anaemia: 13 cm Jejunal Venous Haemangioma

Hansel Gabriel; Tou-Pin Chang; Ajibola Adebisi; Renu Thambi; Bello Abdulazeez

Abstract:

Introduction:
Iron deficiency anaemia (IDA) is frequently attributed to nutritional deficiency, menstrual loss, or chronic gastrointestinal bleeding. When upper and lower endoscopies are unremarkable, small bowel pathology must be considered. Venous haemangiomas of the small intestine are exceptionally rare, comprising less than 0.05% of all gastrointestinal neoplasms. These lesions are usually small, asymptomatic, and often missed on standard imaging. We report a unique case of a large 13 cm jejunal venous haemangioma causing longstanding IDA.

Case Presentation:
A 36-year-old male lorry driver presented with worsening fatigue, exertional dyspnoea, and somnolence. He had a 19-year history of unexplained IDA, with persistently low haemoglobin (Hb 75 g/L) and ferritin (2 µg/L) despite regular iron supplementation. Initial workup, including OGD and colonoscopy, was unrevealing. Ongoing symptoms and positive fecalimmunochemical testing (FIT 39.8) prompted further evaluation. Capsule endoscopy and balloon-assisted enteroscopy identified a suspicious, bleeding lesion in the jejunum. PET-CT and MRI suggested a hypervascular mass concerning for malignancy. Laparoscopic small bowel resection was performed. Histopathology confirmed a 13 cm benign venous haemangioma without evidence of dysplasia or malignancy.

Discussion:
This case highlights the diagnostic challenge of obscure small bowel bleeding. Large venous haemangiomas may mimic malignancies or angiodysplasias on imaging, and their location often delays diagnosis. In this patient, multiple negative investigations over nearly two decades underscore the importance of considering small bowel sources early in chronic IDA, particularly in younger males without overt bleeding. Capsule endoscopy and enteroscopy played pivotal roles in diagnosis and localisation, facilitating definitive surgical management.

Conclusion:
Persistent IDA with negative bidirectional endoscopy warrants early evaluation of the small bowel. Although rare, large venous hemangiomas should be included in the differential diagnosis for obscure gastrointestinal bleeding. Prompt identification and surgical resection can be curative, significantly improving the patient's quality of life.