PG is a capillary-proliferative neoplasm, which does not cause pain. It often exists as stalked or semipedunculated polyps, the color is generally dark black or bright red. The surface is frequently ulcerated. PGs occur on the skin or mucous membrane, and mucosal PGs usually occur in the oral cavity. They seldom develop in the digestive tract , however when they do, they can be a cause of gastrointestinal hemorrhage. Although the pathogenesis remains unknown, infection or irritation-induced granulation is suggested to be concerned, because 38–70.5% of patients are reported to have a history of infection or trauma. Many patients with PG in the oral cavity have experienced chronic irritation such as ill-fitting dental appliances, bites, or sharp teeth. In the gastrointestinal tract, mucosal damage from fish bones or exposure to gastric acid can be chronic irritation which generates PG; whereas, there are also some reports of PG which developed without any trauma or identified trigger (5). Histopathologically, PG is a polypoid hemangioma characterized by a lobular arrangement of capillaries at the base with enlarged vascular endothelial cells and inflammatory cell infiltration in the stroma.
PG in the small intestine is a rare entity. Our search of the PubMed database revealed only 44 reported cases of small intestinal PG . Small intestinal PG is often found as a cause of obscure gastrointestinal bleeding, and capsule endoscopy is the modality that is most likely to effectively detect PG. Surgery or EMR are usually recommended as diagnostic therapies.
Adult intussusception is relatively rare, which occupies 5% of all cases of intussusception. As a cause of mechanical bowel obstructions in adults, it accounts for only 1–5%. The condition differs in many aspects from child intussusception. Child intussusception is generally primary and benign. 80% of the patients can be successfully treated via pneumatic or hydrostatic reduction of the intussusception. On the other hand, almost 90% of adult intussusception are due to a pathologic lead point, such as polyps, benign and malignant tumors, colonic diverticulum, Meckel’s diverticulum and postoperative adhesions, commonly discovered during operation . Because of large proportion of structural anomalies and the high risk of malignancy, approximately 65% [7, 8], surgical resection is most frequently chosen as the treatment .
In our case, the patient was suffering from progressive anemia and small bowel obstruction due to intussusception. Although we considered performing capsule endoscopy or enteroscopy to make an accurate diagnosis, we decided not to, considering the patients situation. Instead, we performed small bowel resection as a diagnostic therapy and the pathology confirmed the diagnosis of PG. In our search of the PubMed database, 3 reported cases of small intestinal PG were associated with intussusception, and only 1 case was complicated by progressive anemia, which required transfusion [10,11,12]. Surgery was performed in all cases.