A Rare Cause of Massive Lower Gastrointestinal Hemorrhage in a Young Patient: Colonic Angiodysplasia

Abstract

Angiodysplasia (AD), also called colonic arteriovenous malformation or colonic angioma, is the most common vascular anomaly of the gastrointestinal tract. It is the second most common cause of lower gastrointestinal (GI) bleeding after diverticulosis in the elderly population (usually over 60 years). In this study, we present a young patient with colonic AD, which caused massive lower GI bleeding. A 46-year-old male patient was referred to our hospital, which was a full-fledged hospital, due to lower GI bleeding. There was no abnormality on physical examination or blood tests, with the exception of hemoglobin, which was only 8 mg/dL. The patient underwent selective visceral angiography due to sub-optimal colonoscopic examination because of bleeding within the lumen. In super-selective ileo-colic arteriogram, bleeding was detected in the ileocecal artery tract and an “arterial embolization + microcoil” procedure was performed. However, the patient underwent emergency operation due to continuing hemorrhage and deterioration of his general medical condition. “Laparoscopic right hemicolectomy + end-to-side ileotransversostomy” was performed in the operation. Histopathological examination of the excised specimen revealed colonic AD. Selective angiography is a very important diagnostic method to identify the location of the lesion, especially in massive GI bleeding in young patients, and it should not be forgotten that AD maybe the etiology. Superselective angiography and embolization are feasible methods for treatment, but it should be kept in mind that surgery may also be necessary in cases of repeated or unstoppable bleeding.