Giant serosal cavernous hemangioma of the ileum: A case report and review of literature

Abstract

BACKGROUND

Small intestinal hemangioma is a rare benign tumor (accounting for 0.05% of intestinal tumors), and there are currently no clinical guidelines. Small intestinal serosal layer hemangioma is even rarer (no epidemiological studies have been conducted), and its pathogenesis remains unclear. This article focuses on a rare case of ileal serosal hemangioma and reviews the relevant literature to enhance clinicians’ understanding of this condition, highlighting the necessity of timely diagnosis and treatment.

CASE SUMMARY

An ileal mass was discovered during the patient’s cesarean section. As its nature remained unclear, it was not addressed at the time. The patient subsequently presented to our hospital for treatment. Upon admission, the patient was asymptomatic with no significant abnormalities on routine laboratory tests. Ultrasound revealed a heterogeneous echo adjacent to the right ovary. Contrast-enhanced computed tomography showed focal thickening of the small intestinal wall. The preoperative diagnosis was small intestinal lymphoma. Laparoscopic exploration revealed a well-defined, red-purple, root-like growth mass measuring approximately 15 cm in length on the serosal layer of the terminal ileum. The procedure was subsequently converted to an open laparotomy, during which segmental resection and intestinal anastomosis were performed. Postoperative pathological diagnosis confirmed a cavernous hemangioma of the ileal serosal layer. Multiple follow-ups over three years after surgery showed no abnormalities.

CONCLUSION

We present a case of ileal serosal hemangioma. Due to its rarity, clinical understanding of this condition remains limited. This article reviews the relevant literature, elaborates on its pathological and physiological characteristics, and highlights the necessity of timely diagnosis and treatment.

Keywords: Giant cavernous hemangioma; Ileum; Serosal layer; Laparoscopic conversion; Case report

Core Tip: This article reports a rare case of ileal serosal cavernous hemangioma. The lesion is fundamentally a vascular malformation rather than a true neoplasm, associated with aberrant activation of the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin signaling pathway due to TEK/PIK3CA gene mutations. Although benign, its pseudo-infiltrative growth pattern and potential risk of delayed rupture can lead to severe complications. This case highlights that even asymptomatic lesions should be evaluated based on their long-term risks, and surgical resection remains the primary curative strategy. Enhanced clinical awareness is crucial for early diagnosis and intervention.