Migrating Site of Bleeding in a Right Colon Demonstrating Angio-Dysplasia following a Segmental Resection of the Colon

Abstract

Background/Aim: A case of angiodysplasia of the right colon presenting with a migrating site of bleeding following a segmental resection of the colon in a 38-year-old Japanese is herein reported. Methods: The case records of a patient with severe intestinal bleeding and multiple surgeries were reviewed, and then the histologic features were compared with the operative findings. The patient received many units of packed red blood cells and had also undergone three segmental colectomies and most recently a curative ileocolostomy. Despite an exhaustive evaluation, the bleeding sites could not be detected clinically. Results: Ectatic, tortuous submucosal veins were presented in four sections of the colon (cecum, ascending colon and transverse colon, respectively) out of a total of 30 sections that were examined. These veins pierced the proper muscle layer of the colon, but did not traverse the muscularis mucosa. Our case of segmental microscopic angiodysplasia may represent a previously unreported unique variant, because the angiodysplastic lesions were present in the segmental colon and they developed bleeding from the distal remnant colon immediately after each segmental colectomy until an extended right hemicolectomy containing the oral part of the descending colon was done. In spite of the severe bleeding, the mucosa of the colon appeared to be essentially normal during a macroscopic inspection. Conclusion: Gastrointestinal bleeding from angiodysplasia is generally assumed to arise from macroscopically visible vascular lesions within the mucosa. However, angiodysplastic lesions are often unrecognizable and multiple in the gastrointestinal tract, and especially tend to affect both the cecum and ascending colon. When this disease process is recognized, a subtotal colectomy may thus be called for to control bleeding.

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

“…This variant is characterized by no recognizable vascular lesions in mucosa on endoscopy but histologically visible ectatic veins, venules, and capillaries in the submucosa that do not pierce into the muscularis mucosa on biopsy. Oshiro et al [7] also reported a case of segmental microscopic angiodysplasia in a 38-year-old man, who experienced multiple operations with segmental resection of colon on 3 occasions because of migrating bleeding sites. However, the present case has some unusual features distinguishing it from previously reported cases as follows: symptoms developed at 5 months of life and the bleeding foci were migrating; the entire colon and terminal ileum were diffusely involved; nodular hyperplasia and erosions at bleeding sites were identified on endoscopy; and submucosal ecstatic veins that pierced the muscularis mucosa and dilated small capillaries in the mucosa were observed on histologic examination.…”

Ileal angiodysplasia presentation as a bowel obstruction: A case report

“…Angiodysplasia is the most common vascular abnormality of the gastrointestinal tract, found mainly in patients older than sixty years without gender predilection [1] , [2] . The lesions are frequently multiple and can involve any segment of the GI tract; but they are most commonly found in the cecum and ascending colon, while 15% of them are located in the small bowel [4] , [5] . Angiodysplasia has varied clinical expressions.…”