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Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding
Jooyoung Lee1, Sung Wook Hwang2, Jihye Kim1
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Abstract:
Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.
Insights
Multiple polypoid angiodysplasia (AD) in the small bowel is rare and can cause severe anemia. This case highlights surgical management for complex AD cases, especially in patients on antiplatelet therapy.
Area of Science:
- Gastroenterology
- Vascular Medicine
- Surgical Oncology
Background:
- Angiodysplasia (AD) is a significant cause of gastrointestinal bleeding.
- While flat lesions are common, polypoid AD is a rare morphological variant.
- Patients on antiplatelet therapy present unique challenges in managing gastrointestinal bleeding.
Purpose of the Study:
- To report a rare case of multiple polypoid angiodysplasia in the small bowel.
- To discuss the diagnostic and therapeutic challenges in managing this condition.
- To highlight the surgical approach for complex cases of angiodysplasia.
Main Methods:
- A 60-year-old male with a history of myocardial infarction on antiplatelet agents presented with severe anemia and hematochezia.
- Diagnostic workup included capsule endoscopy, enteroscopy, computed tomography, and angiography.
- Surgical resection was performed due to the multifocal nature and location of the lesions, and the risk associated with antiplatelet use.
Main Results:
- Multifocal polypoid vascular lesions were identified in the jejunum.
- Histological examination confirmed the diagnosis of angiodysplasia.
- The patient recovered well following surgical resection and resumed antiplatelet therapy.
Conclusions:
- Multiple polypoid angiodysplasia of the small bowel is a rare but significant cause of gastrointestinal bleeding.
- Surgical intervention may be necessary when endoscopic treatment is not feasible.
- Careful consideration of antiplatelet therapy is crucial in the management of patients with angiodysplasia.
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