Refractory Blue Rubber Bleb Nevus Syndrome in an Adult: Limitations of Endoscopic Therapy and Sirolimus

This case describes a 68-year-old man with recurrent gastrointestinal bleeding who was ultimately diagnosed with blue rubber bleb nevus syndrome with small-bowel predominance. Ongoing bleeding persisted despite multiple endoscopic interventions and medical therapy with sirolimus and octreotide, necessitating small-bowel resection. This case underscores the challenges in managing refractory gastrointestinal bleeding in adult late-onset blue rubber bleb nevus syndrome and highlights the potential role of early surgical intervention. The patient's sustained postoperative resolution of symptoms supports consideration of small-bowel resection in selected patients with small-bowel–predominant disease who fail endoscopic and medical therapies.