An unusual case of a colonic vascular anomaly resembling angiodysplasia associated with right sided diverticular disease is presented. [ncbi.nlm.nih.gov]

The patient is presently being followed up. [njcponline.com]

Presentation on theme: "Angiodysplasia of Colon"— Presentation transcript: 1 Angiodysplasia of Colon Joint Hospital Grand Round Angiodysplasia of Colon Yeung Kwan Lok Department of Surgery TKOH 2 Angiodysplasia of Colon Introduction Diagnosis Management [slideplayer.com]

• Massive Splenomegaly

  Myelofibrosis and angiodysplasia of the colon: another manifestation of portal hypertension and massive splenomegaly?. J Clin Pathol. 2004 Sep. 57(9):999-1000. [Medline]. [Full Text]. Schmidmaier R, Bittmann I, Gotzberger M, et al. [emedicine.medscape.com]

• Anemia

  Older people may have symptoms such as: Weakness Fatigue Shortness of breath due to anemia They may not have bleeding directly from the colon. [ufhealth.org]

  The patient presented with anemia unexpectedly before her aortic valve replacement. Colon fiberscopy revealed that colonic angiodysplasia was responsible for the bleeding. [ncbi.nlm.nih.gov]

  Tachycardia ( rapid heart rate ) and hypotension are signs of significant blood loss or long standing anemia and need to be assessed immediately. [healthhype.com]

  Treatment depends on whether the abnormal blood vessels are bleeding, and if you have anemia. In most cases, people only need treatment if the abnormal blood vessels are bleeding or they have anemia. [gandhofcny.com]

• Asymptomatic

  OBJECTIVE: The prevalence of colonic angiodysplasia (AD) among healthy asymptomatic people is unknown, and the natural history of these lesions has not been clearly defined. [ncbi.nlm.nih.gov]

  We compared the UGIB group from angiodysplasia with an asymptomatic control group. The asymptomatic control group was composed of 58 individuals who had incidental findings of angiodysplasia in a health screening center, St. [kjim.org]

  Dig Ds Sci 1991; 36: (c) Aortic stenosis (d) von Willebrand's disease (e) pulmonary disease No study demonstrate the relationship unrelated to inherited arteriovenous malformations (hereditary hemorrhagic telangiectasia) 10 Asymptomatic Presentation GIB [slideplayer.com]

  Cases of angiodysplasia in individuals less than 40 years have been documented in the literature. [5], [10] It may be asymptomatic, or present with iron deficiency anemia or positive occult blood. [njcponline.com]

  The presentation of multiple myeloma can range from asymptomatic to severely symptomatic with complications requiring emergent treatment. [gastrointestinalatlas.com]

• Pallor

  On general physical examination, the patient had pallor but no jaundice or enlarged lymph nodes. Abdominal examination was unremarkable, no viscera or mass palpable. On digital rectal examination, no abnormality was detected. [ispub.com]

• Congestive Heart Failure

  Underlying comorbidities, such as chronic liver disease, chronic renal disease, congestive heart failure, hypertension, and diabetes mellitus, were not associated with UGIB from angiodysplasia. [kjim.org]

• Melena

  Black, tarry stools ( melena ) and occasional episodes of bright red blood rectal bleeding ( hematochezia ) may be the only obvious signs of angiodysplasia. [healthhype.com]

  Overt bleeding consisted of hematemesis in 3 cases, melena in 34 cases and hematochezia in 18 cases.The sites involved in angiodysplastic lesions were: gastric in 18 cases (26%), small bowel 14 (20%), colon 53 (77%), including predominantly the right [latunisiemedicale.com]

  The patient was in good health with no history of GI bleeding, such as melena or hematochezia. He had no symptoms. Regarding laboratory findings, his hemoglobin was 14.7 g/dL and hematocrit was 42.3%. [saudijgastro.com]

  The severity of bleeding ranges from minor, but chronic upper GI blood loss to severe melena and hematemesis that leads to anemia and requires blood transfusion. [bmcgastroenterol.biomedcentral.com]

  Signs and symptoms [ edit ] Although some cases present with black, tarry stool ( melena ), the blood loss can be subtle, with the anemia symptoms predominating. Fecal occult blood testing is positive when bleeding is active. [en.wikipedia.org]

• Hematochezia

  There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. [njcponline.com]

  Black, tarry stools ( melena ) and occasional episodes of bright red blood rectal bleeding ( hematochezia ) may be the only obvious signs of angiodysplasia. [healthhype.com]

  Table 1: Summary of colonic polypoid arteriovenous malformations reported in the English-language literature Click here to view The most common initial clinical symptom was hematochezia (60%). [saudijgastro.com]

  Overt bleeding consisted of hematemesis in 3 cases, melena in 34 cases and hematochezia in 18 cases.The sites involved in angiodysplastic lesions were: gastric in 18 cases (26%), small bowel 14 (20%), colon 53 (77%), including predominantly the right [latunisiemedicale.com]

  Clinical presentation of UGIB from angiodysplasias is usually characterized by maroon-colored stool, melena, or hematochezia. Bleeding usually is self-limited, but it can be chronic, recurrent, or even acute and life threatening. [kjim.org]

• Acute Abdomen

  Angiodysplasia (vascular malformations) of the colon presenting as an acute abdomen. J Pediatr Surg. 2012 Oct. 47(10):e37-40. [Medline]. Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH. Angiodysplasia. [emedicine.medscape.com]

• Heart Disease

  CONCLUSIONS: Multiple and small colonic angiodysplasia lesions in patients of advanced age, with heart disease, or receiving anticoagulants have increased risk for bleeding. [ncbi.nlm.nih.gov]

  The technique is safe and can be used without undue risk, even for patients with substantial comorbidities such as chronic renal failure or ischemic heart disease. [latunisiemedicale.com]

  Other factors that make vascular disease more likely include Family history of vascular or heart diseases Pregnancy Illness or injury Long periods of sitting or standing still Any condition that affects the heart and blood vessels, such as diabetes or [icdlist.com]

  CASE REPORT A 73-year-old man, with previous history of diabetes mellitus, arterial hypertension and coronary heart disease, has been admitted for iatrogenic colonic perforation. [ghrnet.org]

• Hypertension

  2011 "Patients Super Obèses et anneau gastrique ajustable, étude descriptive de 365 cas" - Mémoire Université de Nancy I, Faculté de Médecine Henry Poincaré. 2010 "What about systematic search of Microalbuminuria" - Intervention Third Master Course on Hypertension [doctolib.fr]

  However, GAVE and PHG are considered to be separate clinical entities because of the frequent presence of GAVE in the absence of portal hypertension [ 21 ]. [bmcgastroenterol.biomedcentral.com]

  Munich MARCELLA RIETSCHEL 1898 Department of Psychiatry 1899 SOPHIE NICOLE Germany 1901 ALFRIED KOHLSCHÜTTER 1918 GIORA Z FEUERSTEIN Department of Dermatology Venerology and Allergy University Hospital SchleswigHolstein 1925 Division of Nephrology and Hypertension [books.google.de]

  Surprisingly endoscopic APC therapy was not associated with lower rates of recurrent bleeding. [86] Different types of gastric vascular ectasia include focal vascular ectasia, portal hypertensive gastropathy, and GAVE. [emedicine.medscape.com]

  CASE REPORT A 73-year-old man, with previous history of diabetes mellitus, arterial hypertension and coronary heart disease, has been admitted for iatrogenic colonic perforation. [ghrnet.org]

• Vascular Disease

  You are more likely to have vascular disease as you get older. [icdlist.com]

  Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143. Reviewed By: Michael M. [ufhealth.org]

  Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 37. Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. [medlineplus.gov]

  Atherosclerotic peripheral vascular disease is another comorbidity that could further damage the intestinal vessel walls, especially in older patients, compromising the microcirculation of the large bowel. [10], [11], [12], [13] In favor of the theory [sjkdt.org]

  Angiodysplasia of the colon: An expression of occlusive vascular disease. Hepatogastroenterology 1987;34:127-31. 3. Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 1993;88:807-18. 4. [saudijgastro.com]

Endoscopic treatment resulted in a therapeutic success rate of 100 %, and no recurrence of bleeding was observed in 85 % of the patients (11/13) after treatment. [ncbi.nlm.nih.gov]

Removal of the entire right side of the colon (right hemicolectomy) is the treatment of choice for someone with this condition who continues to bleed at a dangerously quick rate, despite several treatments by angiography and colonoscopy.Hormonal therapy [medigoo.com]

In two others, the need for transfusions was lessened considerably after treatment. The last patient died of terminal cardiac failure. No complications occurred during treatment. [link.springer.com]

Imaging tests may include: Colonoscopy Upper GI endoscopy Capsule endoscopy Abdominal CT scan Angiography Treatment Talk with your doctor about the best treatment plan for you. [cancercarewny.com]

(Outcomes/Resolutions) The prognosis of Gastrointestinal Angiodysplasia is generally excellent with adequate and appropriate treatment. [dovemed.com]

(< 5 mm) of contrast enhancement in the bowel wall (most prominent in the enteric phase 3 ) early filling of an antimesenteric vein 4 Angiography ectatic vessels but no mass 6 early venous enhancement indicating arteriovenous shunting Treatment and prognosis [radiopaedia.org]

Outlook (Prognosis) People who have bleeding related to this condition despite having had colonoscopy, angiography, or surgery are likely to have more bleeding in the future. The outlook remains good if the bleeding is controlled. [ufhealth.org]

Controversial issue Conclusion 26 Conclusion Angiodysplasia - common cause of LGIB of elderly Diagnosis – difficult, combination techniques Treatment – individualized Controversial - systemic hormonal therapy - incidental angiodysplasia 27 Conclusion Prognosis [slideplayer.com]

However, case reports exist of occurrence in young people. [44] Prognosis The prognosis in patients with angiodysplasia is favorable because most angiodysplasias spontaneously cease bleeding (90% of cases). [emedicine.medscape.com]

Etiology and pathogenesis are unknown. The diagnosis can be made with angiography based on the demonstration of a vascular tuft and early opacification of draining veins. Right hemicolectomy is the mode of therapy. [ncbi.nlm.nih.gov]

While there are recognized limitations to this technique, including the inability to detect active bleeding, this small study shows that helical CT angiography may have a role in the diagnostic evaluation of patients with lower GI bleeding of unclear etiology [aafp.org]

Etiology: Thought to be caused by the higher wall tension of cecum (due to larger diameter) and result from (intermittent) venous occlusion/focal dilation of vessels. [2] Gross Cecum - classic location. [librepathology.org]

The condition occurs mainly in older women and is of unknown etiology. [merckmanuals.com]

On the nature and etiology of vascular ectasias of the colon: degenerative lesions of aging. Gastroenterology 1977;72:650–60. PubMed Google Scholar 8. Groff WL. Angiodysplasia of the colon. Dis Colon Rectum 1983;26:64–7. PubMed Google Scholar 9. [link.springer.com]

We investigated the epidemiology and management of colonic angiodysplasia by using a national endoscopy database. [ncbi.nlm.nih.gov]

Am J Gastroenterol. 1989;84: 9 Epidemiology (b) Cirrhosis Naveau S et al. [slideplayer.com]

May be associated with aortic stenosis; known as Heyde syndrome. [1] Epidemiology: Older people. [librepathology.org]

Bleeding can also be acute. 2/3 of cases in patients >70 years of age Epidemiology Incidence The exact incidence of angiodysplasia is unknown. [unboundmedicine.com]

Crossref Google Scholar [9] Cappell MS, Gupta A: Changing epidemiology of gastrointestinal angiodysplasia with increasing recognition of clinically milder cases: angiodysplasia tend to produce mild chronic gastrointestinal bleeding in a study of 47 consecutive [degruyter.com]

Lesions are usually located in the right colon and, although the pathophysiology is unknown, most are probably acquired as the result of a degenerative process associated with aging. [ncbi.nlm.nih.gov]

Etiology and Pathophysiology Exact pathophysiology is unknown. Lesions develop from chronic, low-grade obstruction of submucosal veins as a result of increased smooth muscle contractility. [unboundmedicine.com]

Vascular ectasias also occur in association with a number of systemic diseases (eg, renal failure, cirrhosis, CREST syndrome [calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias]—see Pathophysiology ) and after [merckmanuals.com]

Of note, the aforementioned pathophysiologic mechanisms responsible for the development of cecal lesions are unlikely to apply to lesions in the upper GI tract, despite being morphologically identical. [emedicine.medscape.com]

Prevention There are no current guidelines to prevent angiodysplasia of the colon. [cancercarewny.com]

Prevention There is no known prevention. Images References Brandt LJ, Aroniadis OC. Vascular disorders of the gastrointestinal tract. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. [ufhealth.org]

There is no known way to prevent angiodysplasia of the colon. Last reviewed November 2008 by ]]> Daus Mahnke, MD ]]> Please be aware that this information is provided to supplement the care provided by your physician. [empowher.com]

There is no known prevention. Vascular ectasia of the colon; Colonic arteriovenous malformation; Hemorrhage - angiodysplasia; Bleed - angiodysplasia Brandt LJ, Aroniadis OC. Vascular disorders of the gastrointestinal tract. [medlineplus.gov]