Multifocal Small Bowel Angioectasias: Managed with Innovative, Nonresectional Surgical Procedure

Abstract

Gastrointestinal (GI) angioectasias/angiodysplasias are the most frequent vascular lesions of GI tract, responsible for ∼5 to 6% of GI bleedings. It commonly involves the small bowel, making it difficult to diagnose and manage endoscopically. Though medical management has been used to prevent bleeding, it has only a limited role in acute severe hemorrhage. In such cases, surgical resection remains the only practical option. However, multiple lesions pose a unique challenge, as resection may not be advisable for long length of bowel involvement. Here, we report a case of recurrent GI bleeding due to multifocal small bowel angioectasias who was managed by a novel technique of full-thickness transmural sutures under intraoperative enteroscopic guidance. At 6 months follow-up, no new bleeding episodes were observed.

Management of small bowel angioectasias diagnosed during video capsule endoscopy

“…In view of this, surgical management is not considered first-line and is used only if the cause of small bowel bleeding is unresponsive to other treatments. A recent case report describes multiple angioectasias identified during an exploratory laparotomy, treated with full thickness sutures under guidance of intraoperative enteroscopy [ 55 ]. Lai et al also report on SBAs treated surgically [ 56 ].…”