Colonic angiodysplasia with adenomatous epithelial foci (original) (raw)
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Journal of Clinical Pathology, 1982
We studied 14 large bowel resections from patients with a provisional clinical diagnosis of a bleeding vascular lesion of the colon. For the purpose of this study we developed a barium-gelatine vascular injection technique. Six of the 14 cases were proven to be angiodysplasias with an identifiable mucosal vascular ectasia. The pathological findings in these six cases are described. We conclude that angiodysplasias represent a significant cause of lower gastrointestinal haemorrhage in the elderly. It is our opinion that only the mucosal vascular ectasia seen in these cases is histologically diagnostic and that sub-mucosal venous ectasia, while characteristic of angiodysplasia, is non-specific. The differential diagnostic features which will allow the histological distinction of angiodysplasia from other vascular lesions of the colon are discussed.
Ileal angiodysplasia presentation as a bowel obstruction: A case report
International Journal of Surgery Case Reports, 2017
INTRODUCTION: Angiodysplasia is a common vascular abnormality of the gastrointestinal tract, found in the elderly and most frequently revealed by gastrointestinal bleeding. We report an original case of ileal angiodysplasia in an 83-year-old woman presenting as a bowel obstruction. CASE PRESENTATION: An 83-year-old woman with a medical history of chronic untreated anemia, presented with cardinal symptoms of bowel obstruction. Computed tomography revealed diffuse ileal wall thickening with multiple zones of stenosis, which were aggravated by an ileal perforation and associated with vascular abnormalities compatible with angiodysplasia. Surgery confirmed the imaging findings. A large resection importing one meter of ileum was performed. The pathology report of the resected specimen revealed ischemic lesions of ileum associated with ileal angiodysplasia. The postoperative period was marked by an acute dehydration in the patient who died 3 weeks after surgery. DISCUSSION: Angiodysplastic lesions develop with aging due to chronic low-grade intermittent obstruction of submucosal veins. These lesions are the result of increased contractility at the level of muscularis propria, leading to congestion of the capillaries and failure of pre-capillary sphincters, resulting in the formation of small arteriovenous collaterals. The acquired arteriovenous malformation consisting of multiple shunts with rapid blood flow may result in inadequate oxygenation of a segment of the intestine and lead to ischemia and eventually wall thickening, stenosis and even perforation of the small bowel. CONCLUSION: Angiodysplasia should be kept in the back of one's mind as one of the causes of acute abdomen and bowel obstruction, especially in elderly people suffering from occult gastrointestinal bleeding.
An Unusual Endoscopic Image of a Submucosal Angiodysplasia
Case Reports in Gastrointestinal Medicine, 2012
Obscure gastrointestinal bleeding is responsible for 2–10% of the cases of digestive bleeding. Angiodysplasia is the most common cause. The authors report a case of a 70-year-old female patient admitted to our Gastrointestinal Intensive Care Unit with a significant digestive bleeding. Standard upper and lower endoscopy showed no abnormalities, and we decided to perform a capsule enteroscopy that revealed a submucosal nodule with active bleeding in the jejunum. An intraoperative enteroscopy confirmed the presence of a small submucosal lesion with a central ulceration, and subsequently a segmental enterectomy was performed. Surprisingly, the histopathological diagnosis was angiodysplasia. The patient remains well after a two-year period of follow-up. We present this case of obscure/overt gastrointestinal bleeding to emphasize the role of capsule and intraoperative enteroscopy in the evaluation of these situations, and because of the unusual endoscopic appearance of the angiodysplasia ...
1987
SUMMARY Theinvestigation andtreatmentof131patients with'obscure' gastrointestinal bleeding hasbeenreviewed. Onehundred andsixpatients were assessed electively forrecurrent haemorrhage, 25presented as emergencies. Themajorpresenting feature was melaena(55 patients), anaemia (35), rectal bleeding (34), haematemesis (six) andileostomy bleeding (one). Thelesions responsible forhaemorrhage were colonic angiodysplasia (52patients), small bowel vascular anomalies (16), Meckel's diverticula (nine), smallbowelsmoothmuscle tumours (seven), gastric vascular anomalies (four), chronic pancreatitis (three), colonic diverticular disease (three) and16other miscellaneous lesions. Nolesion was foundin21cases.Lesions were first shownbyvisceral angiography (69patients), atlaparotomy (23), on endoscopy (11), on gastrointestinal contrast radiological studies (four), andatERCP (three). Lesions whichwere undetectable atoperation increased markedly with age(p<0O0001). Expert visceral angiogra...
Rôle de l’endoscopie dans le traitement de l’angiodysplasie du côlon
Acta Endoscopica, 2002
The role of endoscopy in the diagnosis and treatment of colic angiodysplasia RI~SUMI~ Au cours de ces 20 derni~res ann6es, les techniques endoscopiques n'ont pas seulement permis d'identifier les causes de l'h6morragie mais 6galement de la traiter. De juillet 1999 ~ juin 2001, nous avons observ6 17 patients atteints de rectorragies : 9 hommes et 8 femmes (moyenne d'~ge : 78,1 ans). Nous avons r6alis6 26 endoscopies chez 17 patients. Deux artOriographies et 3 scintigraphies ont 6t6 r6alis6es 6galement lorsque la coloscopie n'6tait pas suffisante pour localiser le si~ge de l'h6morragie. Le diagnostic a 6tO pos6 chez 12 patients (70.6 %) ; l'artOriographie s'est avOr6e positive dans un des 2 cas et la scintigraphie dans 2 cas sur 3 seulement pour localiser le si~ge de l'hOmorragie. 11 patients ont Ot6 soumis ~ une intervention chirurgicale. L'utilisation de l'endoscopie est une approche diagnostique satisfaisante permettant d'identifier le si~ge des 16sions angiodysplasiques.
Small Bowel Lymphangiectasia and Angiodysplasia
Journal of Clinical Gastroenterology, 2010
Introduction: Small bowel angiodysplasia accounts for 30 to 40% of cases of obscure gastrointestinal bleeding and is associated with significant morbidity and mortality. Identifying lesions can be difficult. Small bowel capsule endoscopy (SBCE) is a significant advance on earlier diagnostic techniques. The cause of angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing, local vascular anomalies, and tissue hypoxia. Nonpathologic lymphangiectasias are commonly seen throughout the small bowel and are considered a normal finding. Aims: To determine whether there is an association between lymphangiectasias, angiodysplasia, and atherosclerosis related conditions. Methods: Relevant information was collected from a dedicated SBCE database. Logistic regression analysis was used to examine associations between angiodysplasia, lymphangiectasia, patient demographics, and comorbidity. Results: In all, 180 patients underwent SBCE during the study period, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasia were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure gastrointestinal bleeding without angiodysplasia and in 7 (14%) of 50 without gastrointestinal bleeding. Logistic regression analysis confirmed a strong positive association between angiodysplasia and lymphangiectasia; odds ratio 4.42, P<0.003. Angiodysplasias were also associated with increasing age; odds ratio 1.1. There was no correlation with any other patient characteristic. Conclusions: Lymphangiectasia are strongly associated with the presence of small intestinal angiodysplasia and may represent a useful clinical marker for this condition. Angiodysplasia are also associated with increasing age. Conditions associated with systemic atherosclerosis did not increase the risk of angiodysplasia.