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Diffuse microscopic angiodysplasia and nodular lymphoid hyperplasia in an infant with obscure massive lower
Soon-Ok Choi1, Woo-Hyun Park, Jin-Bok Hwang
1Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 700-712, Republic of Korea. choi1635@damc.or.kr
Insights
A rare case of microscopic angiodysplasia and lymphoid hyperplasia caused massive lower gastrointestinal bleeding in a child. Diagnosis was challenging, requiring surgical exploration to identify all bleeding sites.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Vascular Malformations
Background:
- Recurrent massive lower gastrointestinal bleeding in infants can be challenging to diagnose.
- Obscure gastrointestinal bleeding necessitates thorough investigation to identify the source.
Observation:
- A 13-month-old girl presented with recurrent, massive lower gastrointestinal bleeding.
- Colonoscopy revealed nodular lymphoid hyperplasia and mucosal erosions but no definitive bleeding source.
- Other diagnostic studies were negative, indicating an obscure origin.
Findings:
- Diffuse microscopic angiodysplasia and nodular lymphoid hyperplasia were found in the distal ileum and colon.
- Intraoperative transluminal endoscopic transillumination aided in identifying some bleeding foci during laparotomy.
- This technique, however, did not detect all angiodysplastic lesions.
Implications:
- Microscopic angiodysplasia and lymphoid hyperplasia are rare causes of severe pediatric gastrointestinal bleeding.
- Diagnostic challenges highlight the need for advanced intraoperative techniques in obscure bleeding cases.
- Comprehensive surgical assessment may be crucial for complete identification and management of diffuse vascular lesions.
Abstract:
The authors report a rare case of diffuse microscopic angiodysplasia and nodular lymphoid hyperplasia involving the distal ileum and total colon in a 13-month-old girl who had recurrent episodes of massive lower gastrointestinal bleeding of obscure origin. Colonoscopy showed multiple nodular hyperplasia and mucosal erosions, and all other diagnostic studies were negative. At laparotomy, intraoperative transluminal endoscopic transillumination was of benefit in identifying the bleeding foci but could not detect every angiodysplastic lesion.