Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2015; 7(5): 567-572
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.567
Anaemia in Waldmann’s disease: A rare presentation of a rare disease
Shahira A El-Etreby, Ahmed Y Altonbary, Mohamed El Sorogy, Wagdi Elkashef, Jehan A Mazroa, Monir H Bahgat
Shahira A El-Etreby, Ahmed Y Altonbary, Mohamed El Sorogy, Wagdi Elkashef, Jehan A Mazroa, Monir H Bahgat, Divisions of Hepatology and Gastroenterology, Pathology, and Diagnostic Radiology, Specialized Medical Hospital and Gastrointestinal Surgery Center, Mansoura 35516, Egypt
Author contributions: All authors performed the research, designed, wrote, critically analysed the manuscript; El-Etreby SA, Altonbary AY and Bahgat MH were responsible for medical assessment and follow up of the patient; Mazroa JA was responsible of radiological assessment; Elkashef W examined the pathological specimens; El Sorogy M performed the surgical procedure; finally, El-Etreby SA and Bahgat MH analyzed the data, revised the draft and approved of the final version of the paper to be published.
Supported by Specialized Medical Hospital and Gastrointestinal Surgery Center, Mansoura University, Mansoura, Egypt.
Ethics approval: The study was reviewed and approved by the Mansoura Faculty of Medicine Institutional Review Board, Mansoura University, Egypt.
Informed consent: The study participant, or her legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shahira A El-Etreby, MD, Divisions of Hepatology and Gastroenterology, Pathology, and Diagnostic Radiology, Specialized Medical Hospital and Gastrointestinal Surgery Center, Ghomhria street, Mansoura 35516, Egypt. aly_shahira@yahoo.com
Telephone: +2-114-3543995 Fax: +2-50-2230287
Received: October 11, 2014
Peer-review started: October 11, 2014
First decision: November 14, 2014
Revised: November 29, 2014
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: May 16, 2015
Processing time: 219 Days and 4.9 Hours
Abstract

A 32-year-old female presented with 5-year history of iron deficiency anemia, marked pallor and edema of both lower limbs. Laboratory investigations including complete blood count, blood film, iron studies, lipid profile, ascitic fluid analysis, test of stool for occult blood and alpha 1 anti-trypsin. Upper, lower gastrointestinal (GIT) endoscopies, and enteroscopy were performed. Imaging techniques as abdominal ultrasonography and computed tomography were done. Echocardiography, lymph node biopsy and bone marrow examination were normal. The case was diagnosed as Waldmann’s disease with protein losing enteropathy and recurrent GIT bleeding. Management started with low fat diet with medium chain triglyceride, octreotide 200 μg twice a day, tranexamic acid and blood transfusion. Then, exploratory laparotomy with pathological examination of resected segment was done when recurrent GIT bleeding occurred and to excluded malignant transformation.

Keywords: Waldmann’s disease; Lymphangiectasia; Gastrointestinal bleeding; Iron deficiency anemia

Core tip: To our knowledge, this is the first “Egyptian” case of primary intestinal lymphangiectasia. In addition, its presentation is rare with blood loss anemia in contrast to the more common presentation with hypoproteinemia and edema. So, we are reporting a case with a rare clinical presentation of a rare disease. Double balloon enteroscopy was so beneficial in the diagnosis of the case superior to capsule endoscopy because the advantage of biopsy and histopathologic examination. There is controversy about medical treatment options, surgical treatment may be preferred in localized lesions otherwise, has no role. Prognosis may be favorable.