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Intestinal vascular anomalies in children
B Frémond1, S Yazbeck, J Dubois
1Department of Radiology, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Insights
Intestinal vascular anomalies are rare causes of childhood gastrointestinal bleeding. Angiography is crucial for diagnosis and precise localization, enabling effective surgical or conservative treatment.
Area of Science:
- Pediatric Gastroenterology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Gastrointestinal bleeding in children can stem from uncommon vascular anomalies.
- Confusing nomenclature complicates diagnosis and treatment consensus for these lesions.
Purpose of the Study:
- To clarify the diagnosis and management of intestinal vascular anomalies in children.
- To propose a classification based on natural history and clinical findings.
Main Methods:
- Retrospective review of pediatric patients with intestinal vascular anomalies (1975-1995).
- Analysis of clinical presentation, diagnostic methods (primarily angiography), treatment, and pathology.
- Identification of lesion types: isolated venous malformations and arteriovenous malformations.
Main Results:
- Thirteen lesions were identified in nine children; median onset age was 8 years.
- Angiography was essential for diagnosis and localization; intraoperative identification was challenging.
- Pathology revealed dilated veins in the mucosa and submucosa.
Conclusions:
- Selective angiography is vital for diagnosing gastrointestinal bleeding when other investigations are negative.
- Precise preoperative angiographic localization is essential for safe and limited surgical resection.
- A proposed classification aims to improve understanding and management of these anomalies.
Abstract:
Vascular anomalies are an uncommon cause of gastrointestinal bleeding in childhood. Confusing nomenclature has made objective comparisons of published cases difficult and has interfered with an established consensus regarding diagnosis and therapeutic modalities. The purpose of this study was to clarify the situation by reviewing the records of all children who had intestinal vascular anomalies who were referred to our institution from 1975 to 1995. Thirteen lesions were identified in nine children (five boys and four girls). The median age at clinical onset was 8 years. Only two patients presented with a complex syndrome (Klippel-Trenaunay, 1; Osler-Rendu-Weber, 1). Diagnosis, location, and extension of these anomalies was only possible by angiography, which indicated that seven patients had isolated venous malformations and two had arteriovenous malformations. Because the lesions did not involve the serosa, intraoperative localization was a major problem. The main findings were a few slightly dilated mesenteric veins. Treatment was conservative in four children and surgical in five. Pathological findings on resected bowel demonstrated dilated and abnormal veins in the mucosa and submucosa. Selective angiography should not be delayed in patients with gastrointestinal bleeding if results of all other investigations are negative. Because these lesions are rarely recognizable on operative inspection, precise preoperative angiographic localization of intestinal vascular anomalies is essential to allow for a safe and limited resection of the involved bowel segment. Based on a better understanding of the natural history of these lesions, a classification of vascular anomalies of intestines in children is proposed.