Vascular anomalies of the large bowel
G Pellino1, G Candilio, G S De Fatico
1Unit of Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy - gipe1984@gmail.com.
Insights
Vascular malformations of the colon (VMC) are rare but serious conditions, often causing bleeding. Early endoscopic diagnosis and treatment are key, with surgery or angiology for complex cases.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Vascular malformations of the colon (VMC) are rare conditions with significant morbidity and mortality risks.
- These anomalies predominantly affect the caecum and ascending colon, typically in individuals over 50 years old.
Purpose of the Study:
- To provide a practical, up-to-date review of VMC, focusing on pathogenesis, diagnosis, and treatment.
- To synthesize current literature for a readily applicable clinical summary.
Main Methods:
- A narrative review of existing literature on VMC.
- Discussion of pathogenesis, diagnostic modalities, and therapeutic strategies.
Main Results:
- Over 70% of VMC occur in the caecum and ascending colon, primarily in patients >50 years.
- Lower gastrointestinal bleeding is the most common symptom, necessitating endoscopic identification and treatment.
- Endoscopic treatment is primary; interventional angiology or surgery are required for treatment failures or unsuitable cases.
Conclusions:
- VMC are rare, potentially life-threatening conditions requiring prompt management.
- Advances in endoscopic techniques have improved treatment outcomes.
- Long-term follow-up is essential due to a potential relapse rate of up to 40%.
Abstract:
Vascular anomalies of the large bowel, commonly known as vascular malformations of the colon (VMC), constitute a rare but important condition, potentially causing significant morbidity and mortality. Our aim is to provide an up-to-date, practical summary evaluating this disease entity, focussing on pathogenesis, as well as diagnostic and therapeutic modalities. We reviewed available data in the literature, and discussed it in the form of a narrative, readily applicable review. Most VMC (over 70%) are detected in the caecum and ascending colon, and affect people aged over 50 years. VMC are almost always symptomatic, presenting with lower bleeding. Endoscopy is crucial to identify and locate VMC, and to treat the lesions. In patients who fail or do not fit endoscopic treatment, aggressive approaches (interventional angiology or surgery) are mandatory. Up to 40% of patients may have relapse in the long term. VMC are rare but potentially life-threatening. Advances in endoscopic imaging and therapy have improved the results of treatment. Long-term follow-up after treatment is recommended.
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