Vascular Malformations of the Right Colon as a Cause of Bleeding in Patients with Aortic Stenosis

Galloway, Shelby J.; Casarella, William J.; Shimkin, Peter M.

doi:10.1148/113.1.11

Cited by 77 publications

(13 citation statements)

References 13 publications

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“…6 However, later reports have shown that the angiodysplasia can be anywhere from the stomach to the colon, 7 and in our case, it was extensive from the jejunum to the terminal ileum. The management of angiodysplasia associated with aortic stenosis has been primarily surgical and supportive.…”

Section: Discussioncontrasting

confidence: 42%

“…3,4 The association of aortic stenosis with obscure gastrointestinal bleeding was first described by Heyde, 1 while McNamara and Austin 5 found a higher incidence of gastrointestinal bleeding in aortic valve lesions compared with mitral valve lesions. In 1974 Galloway et al 6 reported the presence of vascular malformation of the right colon as the cause of obscure gastrointestinal bleeding in aortic stenosis. Various reports have documented the association of aortic stenosis with angiodysplasia of small and large bowel.…”

Section: Discussionmentioning

confidence: 99%

“…There are case reports of improvement of gastrointestinal bleeding following surgical correction of aortic stenosis, a view not accepted by many gastroenterologists or cardiologists. 6 Endoscopic electrocoagulation is advisable in accessible gastric and colonic lesions. 6 If localized vascular ectasia is the site of recurrent bleeding, it can be surgically resected, offering a permanent cure.…”

Section: Discussionmentioning

confidence: 99%

“…6 Endoscopic electrocoagulation is advisable in accessible gastric and colonic lesions. 6 If localized vascular ectasia is the site of recurrent bleeding, it can be surgically resected, offering a permanent cure. However, in our patient, the lesions were extensive and beyond the reach of endoscopic electrocoagulation.…”

Section: Discussionmentioning

confidence: 99%

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Angiodysplasia of the Small Intestine Associated with Aortic Stenosis

et al. 1989

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of the Small Intestine Associated with Aortic Stenosis. 1989; 9(1): 88-89 With the introduction of selective mesenteric angiography, many cases of obscure gastrointestinal bleeding associated with aortic stenosis have been found to be due to angiodysplasia. Here we report a case of extensive angiodysplasia of the small intestine associated with aortic stenosis. Case ReportA 66-year-old Erytrian man was admitted in 1983 with a history of dizziness and generalized weakness as well as melena a few days prior to admission. Physical examination showed a well-built person with evidence of pallor and no evidence of any other skin or mucosal lesions. His pulse rate was 90 beats per minute, of average volume, and blood pressure was 110/70 mm Hg. Cardiovascular exa mination showed no cardiomegaly, and on auscultation there was a normal first heart sound, a soft second sound, and an ejection systolic murmur in the aortic area with conduction to the neck. Findings on abdominal, respiratory, and neurologic examinations were within normal limits.Laboratory investigations revealed hypochromic microcytic anemia with low serum iron and normal renal and liver function tests. Stool specimens were positive for occult blood on three occasions. An upper gastrointestinal endoscopy showed only mild hiatus hernia with no evidence of bleeding. A full colonoscopy revealed normal findings as did small bowel enema.An ECG showed left ventricular hypertrophy and echo calcification of the aortic valve with stenosis. MUGA scan studies showed good contractility of the left ventricle with ejection fraction of 59% consistent with aortic stenosis.With all these investigations, we were unable to localize the site of bleeding, and he was started on an oral iron regimen to which he responded. He was discharged with the advice to continue his oral iron therapy, and we decided to perform mesenteric angiography should the bleeding recur.He was admitted a few times in the next 2 years with pallor and a history of melena. He had repeat upper and lower gastrointestinal endoscopy and barium studies which did not reveal any bleeding source. He denied us a chance to do emergency angiography as his admission to the hospital was always a few days after the episode of melena, and radioisotope studies showed no active bleeding. However, when he was admitted the last time, we did elective mesenteric angiography which demonstrated extensive angioplastic lesions of the small intestine from the duodenum to the right colon (Figure 1).Since he was having recurrent bouts of melena, we offered him the benefit of resection of the most affected areas. On laparotomy, these extensive areas were identified by intraoperative angiography, and two segments of small bowel were resected. Histopathologic examination of these lesions showed classical angiodysplasia. The patient had no more massive melena after this surgery, even though he was admitted once more with mild irondeficiency anemia. DiscussionGastrointestinal bleeding of unknown etiology has been a problem facing physic...

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Section: Discussioncontrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Angiodysplasia of the Small Intestine Associated with Aortic Stenosis

et al. 1989

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“…Angiography is probably 100% reliable in diagnosing angiodysplasia; however, if the lesions are very small, they may be observed by colonoscopy, whereas on angio graphic study they may remain undetected. Conversely, angiography demonstrates lesions that were undetecta ble on colonoscopy [9,31,32], Angiography and colo noscopy may complement each other, and provide the most accurate diagnosis. Angiography provides an accu rate cause of bleeding in 50-70% of patients, and is asso ciated with a serious complication rate of less than 2% [33,34],…”

mentioning

confidence: 99%

Angiodysplasia: Diagnostic Problems and Solutions

Shah¹

1988

Dig Surg

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Gastrointestinal telangiectasias. A source of bleeding in patients receiving hemodialysis

Dave¹,

Romeu²,

Antonelli³

et al. 1984

Archives of Internal Medicine

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Endoscopy was used over a five-year period to determine the cause of acute or chronic gastrointestinal (GI) tract bleeding in 46 patients receiving long-term hemodialysis. Nine (19%) of the patients were found to be bleeding from telangiectasias. We observed the occurrence of such lesions in the stomach, the small bowel, and the colon. Endoscopic cauterization of the lesions in three patients and jejunal resection in another stopped previously recurrent GI tract bleeding.

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Vascular Malformations of the Right Colon as a Cause of Bleeding in Patients with Aortic Stenosis

Cited by 77 publications

References 13 publications

Angiodysplasia of the Small Intestine Associated with Aortic Stenosis

Angiodysplasia of the Small Intestine Associated with Aortic Stenosis

Angiodysplasia: Diagnostic Problems and Solutions

Gastrointestinal telangiectasias. A source of bleeding in patients receiving hemodialysis

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