Duodenal angiodysplasia: case report and literature review

Abstract

BACKGROUND: Angiodysplasia is a distinct mucosal vascular lesion associated with acute or chronic gastrointestinal bleeding. It occurs most frequently in the right colon and is extremely rare. Its etiology is unknown, but theories of its pathogenesis have evolved from its similarity to colonic angiodysplasia and the lesion appears to be associated with renal insufficiency. CASE REPORT: Sixty-five-year-old woman with repeated melena and severe anemia due to angiodysplasia in the first portion of the duodenum. The diagnosis was done by upper endoscopy. As the patient presented repeated gastrointestinal bleeding with hemodynamic instability and recurrent anemia, surgery was indicated. At laparotomy the lesion was identified and resected with an Y-en-Roux reconstruction. The patient went on well at the immediate and late (four years) postoperative periods with no more recurrent gastrointestinal bleeding. CONCLUSION: Although most of the patients suffering from gastrointestinal angiodysplasia goes on well with conservative management, there is a small portion of them that will need a more aggressive approach, as in this case.

Angiodysplasia of the Small Intestine and Colon: a Report of Three Cases.

“…All mentioned above conditions are believed to affect the microcirculation of the gastrointestinal tract limiting further blood supply and, as a consequence, mucosal oxygenation. This makes the hypoxemia and hypoxia of the intestinal wall to be a pathogenetic mechanism of angiodysplasias and proves the degenerative nature of these rare anomalies (5,6).…”

“…Furthermore, angiodysplasias are quite difficult to identify at endoscopic operation as these lesions are typically non-palpable and very small (2-5mm). This makes the histological evaluation essential for the diagnosis of these lesions (1,5).…”

“…Up to 77% of angiodysplasias are located in the proximal colon and 15% in the small intestine, while lesions distributed in any other part of the alimentary tract account only for the remaining 8% (1). These lesions are believed to be one of the most common cause of gastrointestinal bleeding (5,6,8,9). However, it is quite typical for bleedings caused by angiodysplastic lesions to remain asymptomatic or present only with iron deficiency anaemia at a later time (5-7).…”

“…Angiodysplasia, also called vascular ectasia or arteriovenous malformation, is a rare lesion characterized by enlarged, abnormally dilated blood vessels in the mucous or submucous layers of the gastrointestinal tract (1)(2)(3)(4). Usually the lesions of angio-dysplasia develop in the caecum or ascending colon and are less common in the small intestine or upper gastrointestinal tract (3,5,6). Typically the diagnosis is based on endoscopic and histological findings of numerous fragile, distorted blood vessels beneath the epithelial covering.…”

Duodenal angiodysplasia: a case report

“…While the first case of angiodysplasia (AD) was described in the literature in 1839, that term (AD) was first defined in 1974 as abnormal mucosal vessel clusters in the colon. There was a debate regarding its true etiology that had led to having multiple synonymous terms such as angioectasia, arteriovenous malformations (AVM), and vascular ectasia [1][2][3][4].…”