of gastrointestinal tract bleeding

SUMMARY A 23 year old woman presented with facial pain, a right parotid tumour and iron deficiency anaemia. She had several cutaneous venous swellings and tumours with a similar appearance were found in the large bowel. Histological examination of the parotid tumour and angiography of the skin and gut lesions confirmed that they were venous in origin. The aetiology, classification, and complications of disorders of the venous system and the importance of using a tourniquet to examine the peripheral veins is discussed. There is an ill defined group of conditions character-ised by the coexistence of lesions in both the skin and the internal organs. For example, in blue rubber bleb naevus disease haemangiomas in the skin are associ-ated with vascular polyps in the bowel. The latter may give rise to occult or frank gastrointestinal tract bleeding resulting in anaemia. We have recently investigated a woman who presented with anaemia and a unilateral parotid swelling. She also had unusual skin lesions which seemed to arise from veins, and we found vascular tumours with similar appearances in the large bowel. This combination of abnormalities led to the diagno-sis of blue rubber bleb naevus disease. Angiography confirmed that the skin and the bowel lesions were part of the venous system. This case illustrates firstly that careful examination of the skin of patients with anaemia may reveal the cause, and secondly how detailed investigation of vascular lesions helps in classification. Case history A 23 year old shop assistant initially visited her general practitioner because of heavy menstrual bleeding. He thought she was anaemic and pre-scribed oral iron supplements. Three years later, i