Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China.
Department of Gastroenterology, Henan Province Chest Hospital, Chest Hospital of Zhengzhou University, Zhengzhou, China.
Medicine (Baltimore). 2024 Oct 4;103(40):e39984. doi: 10.1097/MD.0000000000039984.
Angiodysplasia (AD) in the gastrointestinal tract is a degenerative vascular condition characterized by vascular dilation, tortuosity, and arteriovenous connections within the mucosal and submucosal layers. AD is a significant cause of lower gastrointestinal bleeding in the elderly, often presenting as chronic, intermittent hemorrhage. The research challenge lies in the potential for multiple and minute AD lesions to be missed during endoscopy, which may lead to post-hemostatic rebleeding.
An 82-year-old female with a history of coronary artery disease treated with aspirin, presenting with recurrent melena and anemia. The patient exhibited a suboptimal response to blood transfusions and octreotide therapy.
After excluding tumorous bleeding in the initial contrast-enhanced computed tomography (CECT), we suspect vascular bleeding as the most probable etiology.
The initial colonoscopy was unsuccessful due to the occurrence of ventricular tachycardia. Considering the patient's advanced age, cardiac dysfunction, and frailty, a repeat CECT were conducted during episodes of suspected active bleeding. Vascular dilatation within the colonic hepatic flexure wall was visualized during the venous phase, accompanied by contrast agent extravasation into the intestinal lumen. The subsequent urgent colonoscopy and pathological specimens from surgical resection supported the diagnosis of colonic AD.
After the surgery, the patient did not experience melena thereafter.
We highlight that CECT for diagnosing AD-related bleeding offers higher safety and convenience, potentially superior to digital subtraction angiography, particularly in critically ill elderly patients.
胃肠道的血管发育不良（AD）是一种退行性血管疾病，其特征为黏膜和黏膜下层的血管扩张、迂曲和动静脉连接。AD 是老年人下消化道出血的重要原因，常表现为慢性、间歇性出血。研究的挑战在于，内镜检查可能会遗漏多个微小的 AD 病变，从而导致止血后再出血。
一位 82 岁女性，有冠心病病史，服用阿司匹林治疗，表现为反复黑便和贫血。患者对输血和奥曲肽治疗反应不佳。
初始增强 CT（CECT）排除肿瘤性出血后，我们怀疑血管出血是最可能的病因。
初始结肠镜检查因发生室性心动过速而失败。考虑到患者年龄较大、心功能不全和虚弱，在疑似活动性出血发作时进行了重复 CECT。静脉期显示结肠肝曲壁血管扩张，造影剂漏入肠腔。随后的紧急结肠镜检查和手术切除的病理标本支持结肠 AD 的诊断。
手术后，患者未再出现黑便。
我们强调，CECT 诊断 AD 相关出血具有更高的安全性和便利性，可能优于数字减影血管造影，特别是对危重症老年患者。
