Clinical Journal of Gastroenterology

, Volume 12, Issue 1, pp 34–37 | Cite as

Pyogenic granuloma of the ampulla of Vater: unexpected cause of gastrointestinal bleeding

  • Helena Moreira SilvaEmail author
  • Gisela Silva
  • Emília Costa
  • Rosa Lima
  • Fernando Pereira
Case Report


We describe the case of a previously healthy 8-year-old girl presenting with a 1-year history of iron deficiency anemia. There was no report of hematemesis, abdominal pain or melena. Laboratory work-up excluded iron malabsorption as the underlying cause. Therefore, endoscopic evaluation was performed to exclude gastrointestinal blood loss, which revealed the presence of a 7 mm reddish lesion located within the ampulla of Vater. Capsule endoscopy excluded alternative diagnoses and concomitant lesions. Histopathological examination confirmed the diagnosis of pyogenic granuloma. The young age of the child and the benign nature of this lesion along with the absence of complications favored conservative management. Pyogenic granuloma is a benign vascular lesion that presents as a polypoid red mass. In the gastrointestinal tract, it is a rare condition and occurs more commonly in the elderly. The most common sites are the small intestine, esophagus, and colon, but they can occur throughout the entire gastrointestinal tract with a propensity to bleed that may cause iron deficiency anemia. In pediatric age patients, there are few reports of gastrointestinal pyogenic granulomas, most of which occur in the colon and rectum. Its identification and location in the ampulla of Vater is an exceptional finding.


Ampulla of Vater Iron deficiency anemia Gastrointestinal bleeding Pyogenic granuloma 


Author contributions

HMS drafted the initial manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted. GS, EC, FP and RL critically reviewed the manuscript and approved the final manuscript as submitted.


  1. 1.
    Moffatt DC, Warwryko P, Singh H. Pyogenic granuloma: an unusual cause of massive gastrointestinal bleeding from the small bowel. Can J Gastroenterol. 2009;23:261–4.CrossRefGoogle Scholar
  2. 2.
    Patrice SJ, Wiss K, Mulliken JB. Pyogenic granuloma (lobular capillary hemangioma): a clinicopathologic study of 178 cases. Pediatr Dermatol. 1991;8:267–76.CrossRefGoogle Scholar
  3. 3.
    Veres G, Lukovich P, Gyorffy H. Pyogenic granuloma. J Pediatr Gastroenterol Nutr. 2011;52:1.CrossRefGoogle Scholar
  4. 4.
    Serban DE, Florescu P. Colonic pyogenic granuloma in children: a rare or rarely recognized entity. Am J Gastroenterol. 2003;98:2106–7.CrossRefGoogle Scholar
  5. 5.
    Tanga S, Bhaijeeb F. Pyogenic granuloma of the ampulla of Vater. Video J Encycl GI Endosc. 2014: 622–624.Google Scholar
  6. 6.
    Demirturk L, Tanoglu A, Oztek I. Vascular hamartomatous lesion of the ampulla Vateri: a very uncommon occurrence. Gastrointest Endosc. 2014;80:347–8.CrossRefGoogle Scholar
  7. 7.
    Korc P, McHenry L. An uncommon cause of chronic upper GI bleeding. Gastrointest Endosc. 2016;84:524.CrossRefGoogle Scholar
  8. 8.
    Lee CK, Dong SH, Jung SH, et al. Pyogenic granuloma of the common bile duct in a patient with choledochoduodenostomy. Endoscopy. 2007;39:E282–3.CrossRefGoogle Scholar
  9. 9.
    Park SY, Park CH, Lee WS, et al. Pyogenic granuloma of the duodenum treated successfully by endoscopic mucosal resection. Gut Liver. 2009;3:48–51.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Pediatric Gastroenterology UnitCentro Materno Infantil do Norte, Oporto Hospital CenterPortoPortugal
  2. 2.Pediatric Hematology UnitCentro Materno Infantil do Norte, Oporto Hospital CenterPortoPortugal
  3. 3.Pediatric Gastroenterology UnitOporto Hospital CenterPortoPortugal

Personalised recommendations