Diffuse microscopic angiodysplasia—A previously unreported variant of angiodysplasia

Abstract

Gastrointestinal bleeding from angiodysplasia is generally assumed to arise from endoscopically recognizable vascular ectasia within the mucosa. Thus, this case helps provide an explanation for some cases in which occult or massive bleeding is assumed to be secondary to angiodysplasia, even when endoscopic verification is not possible. Recognition of this disease process may require segmental resection or deep biopsy of endoscopically normal intestine.

Diffuse microscopic angiodysplasia and nodular lymphoid hyperplasia in an infant with obscure massive lower gastrointestinal bleeding: a diagnostic challenge

“…Weinstock et al [1] described a case of diffuse microscopic angiodysplasia as a variant of angiodysplasia in a 65-year-old woman. This variant is characterized by no recognizable vascular lesions in mucosa on endoscopy but histologically visible ectatic veins, venules, and capillaries in the submucosa that do not pierce into the muscularis mucosa on biopsy.…”

“…However, accurate diagnosis of microscopic angiodysplasia is very difficult and can be delayed because vascular lesions are diffuse and the mucosa remains histologically and endoscopically uninvolved, despite severe bleeding [1]. Exploratory laparotomy and intraoperative transluminal endoscopic transillumination (ITET) may be helpful in detecting the cause of obscure lower gastrointestinal (GI) bleeding even in instances of quiescent angiodysplasia [2].…”

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

“…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).…”

Jejunal arteriovenous malformation, diagnosed by angiography and treated by embolization and catheter-guided surgery: case report and review of literature

“…tinction should be made on the basis of the arterial feeders, characteristics of the vessel walls, and localization within the bowel wall. Unequivocal histopathologic classification of vascular malformations appears essential for studying epidemiology and efficacy of therapeutical modalities including hormone therapy, endoscopic fulgeration, vascular embolization, or surgical resection [6].…”