Angiodysplasia of the small bowel; a ‘brilliant’ technique for localizing the quiescent lesion

Abstract

Summary: Intraoperative transluminal endoscopic illumination is of benefit to locate angiodysplasias of the small bowel at laparotomy in the quiescent non-bleeding phase.

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

“…Scott and Royle [2] advocate ITET as a means of detecting or localizing quiescent angiodysplastic lesions. In our case, repeated colonoscopic biopsies indicated colitis, and repeat studies including angiography, tagged red blood cell scan, and helical computed tomography failed to demonstrate the bleeding foci.…”

“…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]. We describe the first report on a unique case of diffuse angiodysplasia with nodular lymphoid hyperplasia (NLH) involving the distal ileum and total colon in an infant along with a brief literature review.…”

Angiodysplasia: current concepts

“…Recently similar vascular abnormalities have been diagnosed by both endoscopy and angiography in the stomach'13"4 and small intestine. 15 The occurrence of the condition at these sites is less common and it is important to be certain that histologically the lesions represent the same condition and that they fulfil the criteria set out in the definition at the beginning of this article.…”

Massive gastrointestinal haemorrhage associated with ileal lymphoid hyperplasia in Gaucher's disease

“…Smaller diameter endoscopes can be introduced via an enterotomy, as in the case described above, for more rapid intraluminal bowel inspection or transillumination of the bowel wall to identify vascular abnormalities. 25,26 The condition of our patient merited urgent surgery despite the lack of an accurate localization ofbleeding preoperatively. Preoperative ileal endoscopy using the gastroscope enabled the involved area of bowel to be visualized and allowed an effective resection.…”