Vascular ectasias of the right colon in the elderly: A distinct pathologic entity

Mitsudo, Sumi; Boley, Scott J.; Brandt, Lawrence J.; Montefusco, Cheryl M.; Sammartano, Robert J.

doi:10.1016/s0046-8177(79)80101-x

Cited by 66 publications

(20 citation statements)

References 14 publications

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“…The infant was given Vivonex and other supportive therapy. On 2 March the hemoglobin was 11.3 mg/dl, platelet count 99,000/mm 3 , and weight 4800 gm. The infant remained in the hospital for approximately two months and was discharged in relatively good condition.…”

Section: Course In Hospitalmentioning

confidence: 95%

“…With a platelet count above 50,000/mm 3 it is uncommon to have any bleeding. Below this level, bleeding into the skin with purpura and ecchymoses is usual; and severe bleeding, particularly intracranial bleeding and occasionally gastrointestinal bleeding, is usually not seen unless the platelets are nearly absent.…”

Section: Dr Bolesmentioning

confidence: 99%

“…It has been postulated that it is the result of the aging process. 3,4 The second (type II) occurs in the young and is usually large. It is found usually in the small intestine, although occasionally it may occur in the colon or the stomach.…”

Section: Dr Godwinmentioning

confidence: 99%

“…Smear revealed polychromasia, hypochromia, and microcytosis. Platelet count was 76,000/mm 3 . Fibrinogen was 250 mg/dl.…”

mentioning

confidence: 98%

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Clinicopathologic Conference

1985

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Case PresentationAN INFANT, age 2½ months, was referred to this hospital from the Dhahran Health Center with a history of vomiting fresh blood and clots six weeks prior to admission and recurrent melena. She had required three admissions to Dhahran Health Center and at one time was in shock with a hemoglobin of 4.5 gm/dl. There was no history of jaundice. The patient was investigated for bleeding tendency and for anatomical causes of bleeding. She had thrombocytopenia. Studies for DIC were negative. Esophagoscopy and gastroscopy revealed small bleeding points in the stomach. She was referred to the King Faisal Specialist Hospital for further investigation.Parents were not consanguinous; she had seven healthy siblings. There was no family history of bleeding tendency. The patient was the product of a full-term pregnancy and normal vaginal delivery, with no prenatal or neonatal complications. Her development was adequate for her age. She was fed Similac formula and had had no immunizations.On admission she had a height of 60 cm, weight 4.8 kg, temperature 37.7°C, respiratory rate 32/min, pulse 130/min. Height and weight were normal for age. Mucous membranes were pale, but there was no telangiectasis. ENT was negative, lungs clear, and heart regular and rhythmic with no murmurs. On abdominal examination, there was no hepatosplenomegaly, no masses, or bruit; and bowel sounds were normal. Genitalia were normal; examination of extremities showed no abnormalities. Neurologic examination was physiologic.Laboratory data: White blood cell count was 14,900/mm 3 , segmented neutrophils 20, band neutrophils 6, lymphocytes 66, monocytes 2, eosinophils 3, metamyelocytes 2, myelocytes 1, nucleated RBCs 2, hemoglobin 7.6 gm/dl, hematocrit 21.8, mean corpuscular volume (MCV) 78.4 µm 3 , mean corpuscular hemoglobin (MCH) 27.6 µg/dl, mean corpuscular hemoglobin concentration (MCHC) 35.2 gm/dl, reticulocyte 7.2%. Smear revealed polychromasia, hypochromia, and microcytosis. Platelet count was 76,000/mm 3 . Fibrinogen was 250 mg/dl. Prothrombin time was normal. Urinalysis revealed 2 to 3 RBCs per high power field; BUN was 29 mg/dl, creatinine 0.5 mg/dl, sodium 135 mEq/1, potassium 5.5 mEq/1, chloride 105 mEq/1, carbon dioxide 13 mmol/1, liver enzymes were normal, total bilirubin 0.2 mg/dl, total protein 5.2 gm/dl, albumin 3.8 mg/dl, alkaline phosphatase 303 IU/1, lactic dehydrogenase (LDH) 389 IU/1. Several stool specimens were examined and revealed no ova, parasites, fat globules, or fibers. Stools were positive for occult blood. Findings from chest x-ray and upper GI series were negative. Course in hospital:The infant continued to have recurrent melena requiring multiple blood transfusions. Fourteen units of packed cells and multiple platelets and fresh plasma transfusions were given. DIC studies were negative. There was a decreased platelet count. After studies for a bleeding tendency, the child was investigated for anatomical cause of the bleeding. An upper GI series was negative. Upper GI endoscopy revealed multiple hemorrhagic a...

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Section: Course In Hospitalmentioning

confidence: 95%

Section: Dr Bolesmentioning

confidence: 99%

Section: Dr Godwinmentioning

confidence: 99%

“…Smear revealed polychromasia, hypochromia, and microcytosis. Platelet count was 76,000/mm 3 . Fibrinogen was 250 mg/dl.…”

mentioning

confidence: 98%

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Clinicopathologic Conference

1985

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“…A NGIODYSPLASIA OF THE GASTROintesri na I tract is an acquired lesion of small submucosal and muco al blood vessels which can give rise to hemorrhage (1). It is commonly found 111 the colon but also occurs with less frequency in the small intestine and scomach ( 2).…”

mentioning

confidence: 99%

Angiodysplasia Occurring in Jejunal Diverticulosis

Jones¹,

Chaun²,

Switzer³

et al. 1990

Canadian Journal of Gastroenterology

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Angiodysplasia and Lower Gastrointestinal Tract Bleeding in Elderly Patients

Sharma

Gorbien²

1995

Arch Intern Med

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Angiodysplasia of the colon is one of the most common causes of major lower intestinal tract bleeding in the elderly; it occurs predominantly in the cecum and on the right side of the colon and is thought to result from degenerative changes associated with aging. The clinical presentation is varied, ranging from hematochezia or melena to iron-deficiency anemia resulting from long-term blood loss. Accurate diagnosis may require a combination of diagnostic techniques, such as angiography, nuclear scanning, and colonoscopy. The management plan should be individualized for each patient depending on severity, rate of rebleeding, and issues of comorbidity. Although conservative medical management is a reasonable option for many patients, endoscopic treatment has generally replaced surgery as the first line of definitive treatment for angiodysplasias in most of these patients. The risk of rebleeding is a considerable problem, and surgical therapy yields better results in this aspect. The role of hormonal therapy is not clearly established.

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Vascular ectasias of the right colon in the elderly: A distinct pathologic entity

Cited by 66 publications

References 14 publications

Clinicopathologic Conference

Clinicopathologic Conference

Angiodysplasia Occurring in Jejunal Diverticulosis

Angiodysplasia and Lower Gastrointestinal Tract Bleeding in Elderly Patients

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