A Rare Case of Incidental Gastric Hemangioma in the Setting of Non-Cirrhotic Portal Hypertension : A Case Report
This case report describes a rare instance of an incidental gastric cavernous hemangioma discovered during endoscopic screening for non-cirrhotic portal hypertension in an asymptomatic patient, underscoring the importance of accurate diagnosis to prevent unnecessary intervention.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Inside the human body, a complex network of veins acts as a drainage system, carrying blood from the digestive organs back to the liver. When this flow is blocked, pressure builds up in the system, a condition known as portal hypertension. This pressure can cause the veins to swell and become fragile, much like a garden hose kinked under a heavy rock. Doctors often look for these swollen veins, called varices, because they can burst and cause dangerous bleeding. To find them, physicians use a flexible camera passed down the throat to examine the inside of the stomach and esophagus. While searching for these signs of high pressure, they sometimes stumble upon other unexpected growths. Most of the time, these are harmless, but distinguishing a benign lump from something dangerous is critical, as unnecessary treatment can be just as risky as the condition itself.
A recent report from Switzerland details a rare encounter with one such unexpected finding. A forty-eight-year-old woman arrived at a hospital complaining of severe, sudden pain in her abdomen. She had no fever and no digestive issues like diarrhea, but the pain was intense. Doctors performed a detailed scan of her belly and discovered a massive blockage in her veins. The clot stretched across the main vessels that drain the spleen and intestines, effectively cutting off the normal return path for blood. This blockage had caused her spleen to swell to fourteen centimeters, a clear sign that the pressure in her system had risen dangerously high. Further testing revealed the cause: a specific genetic variation in her blood that made it prone to clotting, combined with her habit of smoking. She was immediately started on a medication to thin her blood and prevent the clot from growing.
While treating her blood condition, the medical team also needed to check for the swollen veins that often accompany such blockages. They performed a gastroscopy, a procedure where a camera is used to look inside the stomach. As expected, they found small, swollen veins in her esophagus. However, the camera also revealed something unusual on the inner wall of her stomach, near the exit where food leaves for the intestines. There was a large, flat, red patch of tissue that looked different from the surrounding healthy lining. It appeared to be a collection of blood vessels, a type of growth known as a hemangioma. These are benign tumors made of blood vessels, and while they are common in children, finding one in the stomach of an adult is extremely rare.
The doctors needed to be certain of what they were looking at, so they took a tiny sample of the tissue. The moment the instrument touched the growth, it began to bleed, forcing the team to stop and place a small metal clip to seal the spot. The sample was sent to a laboratory, where a microscope revealed the truth: the tissue was filled with dilated, empty-looking spaces lined with normal cells, confirming it was a cavernous hemangioma. It was not cancer, nor was it a sign of the clotting disorder. It was simply a harmless, benign growth that had been there all along.
Three months later, the woman returned for a follow-up scan. The massive clot in her veins had evolved into a network of smaller, chronic channels, a common outcome for this type of blockage, but her liver function remained normal. The red patch in her stomach was no longer visible on the scan, likely because the camera had seen it directly while the scan could not distinguish it from the surrounding tissue. Most importantly, the woman felt fine. She had never experienced bleeding from the stomach growth, nor did she have any pain caused by it. Because the growth was not causing harm, the doctors decided to leave it alone. No surgery, no removal, and no further treatment were needed.
This case serves as a quiet reminder of the importance of careful observation. When doctors find a strange growth in the stomach, especially in a patient with complex blood issues, the instinct might be to remove it immediately. However, this report shows that some of these growths are simply incidental findings—unrelated curiosities that do not require intervention. By correctly identifying the lesion as a benign hemangioma and understanding that it was not the source of her pain or bleeding, the medical team avoided an unnecessary procedure. The patient continues to be monitored for her underlying blood condition, while the harmless growth in her stomach remains a silent, unremarkable part of her anatomy.
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