Skin vascular malformations and recurrent melena which refers to a nevus syndrome.

To cite: Nayak HK, Raizada N, Sinha N, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-009064 DESCRIPTION A 14-year-old North Indian boy presented with a one-year history of multiple hospitalisation anamnesis for recurrent melaena and anaemia. He had received iron supplementation and whole-blood transfusions of more than 10 units for the last 1 year. On physical examination, we observed multiple dark blue, soft, lobulated lesions (5–20 mm) on his palm, sole and extremities which were present for the last 2 years (figure 1). With the application of direct pressure the contained blood emptied leaving behind a wrinkled sac. Doppler ultrasonography of the abovementioned skin lesions suggested multiple dilated venous lesions filled with blood without any arteriovenous communication. Mucous surfaces of the patient were free of bleb-like lesions and were severely pale. His haemoglobin level was 7 g/dl, with hypochromic microcytosis indicating iron deficiency. Occult blood analysis of the stool was positive on many occasions. Oesophagogastroduodenoscopy revealed bluish venous malformations in stomach and proximal duodenum. Colonoscopy revealed multiple papular venous malformations of approximately 1– 2 cm in size located at the distal, ascending colon and transverse colon (figure 2). In order to search for additional lesions, we carried out double balloon enteroscopy and identified multiple venous malformations in the jejunum and ileum. He was treated with multiple sessions of endoscopic sclerotheraphy of the gastrointestinal (GI) venous lesions in addition to the blood transfusion and iron supplementation. Our patient’s case draws attention to a rare vascular anomaly syndrome predominately involving the skin and whole GI tract. This patient was a case of blue rubber bleb nevus syndrome who was successfully treated with multiple endoscopic therapeutic sessions, transfusion and haematinics supplementation. 2