Deep Seated Lobular Capillary Hemangioma (Pyogenic Granuloma) of the Colon: A Rare Case Requiring Surgery beyond Endoscopic Management.

Background: Lobular capillary hemangiomas typically present as skin or oral mucosa lesions and have rarely been described in unusual sites, including the gastrointestinal tract. Most colonic lobular capillary hemangiomas, either asymptomatic or associated with GI bleeding, have been amenable to endoscopic treatment in literatures. Case Presentation. A 41-year-old woman presented with an incidental colonic mass during a systemic workup after adjuvant chemotherapy for HER2-positive breast cancer. Abdominal computed tomography revealed a deep seated colonic mass in the splenic flexure. An endoscopic strip biopsy was attempted for differential diagnosis of this lesion, but uncontrolled bleeding occurred, and an emergency surgery was eventually performed. Microscopic examination showed lobular capillary hemangioma involving full thickness of the colonic wall with mucosal ulceration. Conclusions: Colonic lobular capillary hemangioma is a benign vascular proliferation but is a candidate in differential diagnosis of benign or malignant tumors. Furthermore, the exceptional case may be deep seated and require more invasive surgery, unlike most cases of colonic lobular capillary hemangioma that can be treated with endoscopic modality.

Standard Recipes for the Preparation of Thickened Barium Liquids Used in the Diagnosis of Dysphagia.

Barium sulfate is commonly used to prepare contrast media for videofluorograpy. The flow characteristics of thickened liquids formulated for oropharyngeal imaging are known to be greatly affected by the addition of barium. In this study, thickened barium liquids were prepared by mixing a commercial xanthan gum (XG)-based thickener (Visco-up®) at different concentrations (0.1%-3.0%) with barium powder (Baritop HD®), and differences in the viscosity between thickened non-barium and thickened barium liquids were investigated. In addition, the thickness levels of thickened barium liquids, which are based on the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) guidelines, were classified by measuring the viscosity (NDD) and gravity flow through a syringe (IDDSI) with 0.1%-3.0% thickener concentrations. The apparent viscosity (ηa,50) values of thickened barium liquids were much higher than those of thickened non-barium liquids, indicating that the addition of barium to the XG-based thickener resulted in further thickening. Standard recipes for preparing thickened barium liquids with desirable thickness levels were also established, showing the different thickener concentrations corresponding to the different NDD and IDDSI levels.