Importance of small bowel involvement in bleeding angiodysplasia

Lower intestinal bleeding related to enterocolic angiodysplasia is now accepted as a common clinical situation in the elderly. A planned approach is mandatory to allow early localization and appropriate therapy. Colonoscopy, scintigraphy and angiography used judiciously have almost entirely replaced exploratory laparotomy as a diagnostic tool. Nonoperative treatment comprising arteriographic selective vasopressin infusion and endoscopic coagulation has been followed in some cases by hemorrhage control. Such techniques, if easily obtainable, have their place; however, surgery remains the ultimate method for definitive treatment. A previous knowledge of the nature of ileal involvement is essential if surgical hemostasis is to be achieved. The recent successful management of three patients exemplifies the problems found in dealing with iliocecal bleeding angiodysplasia.