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Angiodysplasia of the colon in children
L de la Torre Mondragón1, M A Vargas Gómez, M A Mora Tiscarreño
1Department of Surgery, Instituto Nacional de Pediatría, Mexico City, Mexico 53300.
Insights
Pediatric colonic angiodysplasia, a rare cause of lower intestinal bleeding, often presents in infancy. This study highlights left hemicolon involvement and successful surgical resection in children.
Area of Science:
- Pediatric Gastroenterology
- Vascular Malformations
- Colorectal Surgery
Background:
- Angiodysplasia of the colon is a common cause of lower intestinal bleeding in the elderly.
- Experience with colonic angiodysplasia in children is limited, with only six prior reported cases.
- This study focuses on a cohort of pediatric patients diagnosed with this condition.
Purpose of the Study:
- To evaluate the clinical, radiological, and surgical aspects of pediatric colonic angiodysplasia.
- To describe the presentation and management of nine children treated for this condition.
- To compare findings in children with those reported in adult populations.
Main Methods:
- Retrospective review of nine pediatric patients treated between 1970 and 1993.
- Diagnosis and lesion localization using selective visceral angiography.
- Surgical management including resection and Swenson pull-through procedures.
Main Results:
- Mean age at onset was 2.3 years, with six patients symptomatic before age one.
- All patients presented with lower intestinal bleeding and severe anemia.
- The left hemicolon was the most frequently affected area, differing from adult presentations.
- Six patients underwent successful surgical resection; one had a recurrence due to incomplete resection.
Conclusions:
- Colonic angiodysplasia can occur in young children, often presenting with severe bleeding and anemia.
- Selective visceral angiography is crucial for diagnosis and localization.
- Surgical resection is an effective treatment, with the left hemicolon being a common site in pediatric cases.
Abstract:
Angiodysplasia of the colon as a cause of lower intestinal bleeding is diagnosed frequently in the elderly, with defined clinical characteristics. In the pediatric population there is little experience; only six cases have been reported. The present study evaluates the clinical, radiological, and surgical aspects of nine children with angiodysplasia of the colon who were treated at the National Institute of Pediatrics in Mexico City between 1970 and 1993. The mean age of clinical onset was 2.3 years. In six patients, symptoms appeared before the first year of life. Lower intestinal bleeding and severe anemia were present in all cases. The diagnosis and localization of the lesions were established by selective visceral angiography. Six patients were treated by operative resection of the affected colonic segments. For four patients with lesions in the rectum and sigmoid, a Swenson pull-through was performed. In one patient the lesion was recurrent because of incomplete resection. Follow-up ranges from 8 months to 4 years; all patients have had normal hemoglobin levels and negative stool results. Unlike in the elderly and the cases reported in the literature, the left hemicolon was the most frequently involved area.