Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy
A 14-year old boy with anemia due to chronic gastrointestinal bleeding required recurrent transfusion. An extensive non-invasive evaluation that included detection of fresh blood in the small bowel followed by laparotomy with on-table pan-endoscopy (including enteroscopy) was unsuccessful in identif...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-01-01
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| Series: | Journal of Pediatric Surgery Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576616301932 |
| _version_ | 1811298937630359552 |
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| author | Andrew Jackson Murphy Anna P. Lillis Harry P. Kozakewich Ahmad I. Alomari Heung Bae Kim Victor L. Fox |
| author_facet | Andrew Jackson Murphy Anna P. Lillis Harry P. Kozakewich Ahmad I. Alomari Heung Bae Kim Victor L. Fox |
| author_sort | Andrew Jackson Murphy |
| collection | DOAJ |
| description | A 14-year old boy with anemia due to chronic gastrointestinal bleeding required recurrent transfusion. An extensive non-invasive evaluation that included detection of fresh blood in the small bowel followed by laparotomy with on-table pan-endoscopy (including enteroscopy) was unsuccessful in identifying a bleeding source. After repeat capsule endoscopy at our center confirmed bleeding in the distal small bowel, CT angiography identified a 6-mm focal area of enhancement in the ileum communicating with a distal branch of the superior mesenteric artery. Direct visceral angiography with super-selective arteriography identified a fast-flow vascular malformation supplied by terminal branches of the ileal artery.
Diagnostic laparoscopy revealed intra-abdominal adhesions and no clear vascular malformation. Initial careful visual and manual examination of the bowel after conversion to laparotomy failed to identify the lesion. On-table retrograde enteroscopy demonstrated a small, pulsatile lesion without ulceration or adherent clot in the mucosa of the proximal ileum. With endoscopic transillumination, a cluster of serpiginous vessels could be seen within the wall of the small bowel. The lesion was resected and pathology was consistent with angiodysplasia. Angiodysplasia is a rare cause of occult, chronic gastrointestinal bleeding in children. A multidisciplinary approach optimizes the likelihood of therapeutic success. |
| first_indexed | 2024-04-13T06:26:26Z |
| format | Article |
| id | doaj.art-9a671a47c4e24b61a648e378eb994923 |
| institution | Directory Open Access Journal |
| issn | 2213-5766 |
| language | English |
| last_indexed | 2024-04-13T06:26:26Z |
| publishDate | 2017-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj.art-9a671a47c4e24b61a648e378eb9949232022-12-22T02:58:22ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662017-01-0116C464910.1016/j.epsc.2016.10.010Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boyAndrew Jackson Murphy0Anna P. Lillis1Harry P. Kozakewich2Ahmad I. Alomari3Heung Bae Kim4Victor L. Fox5Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USADepartment of Interventional Radiology, Boston Children's Hospital, Boston, MA, USADepartment of Pathology, Boston Children's Hospital, Boston, MA, USADepartment of Interventional Radiology, Boston Children's Hospital, Boston, MA, USADepartment of Surgery, Boston Children's Hospital, Boston, MA, USADivision of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USAA 14-year old boy with anemia due to chronic gastrointestinal bleeding required recurrent transfusion. An extensive non-invasive evaluation that included detection of fresh blood in the small bowel followed by laparotomy with on-table pan-endoscopy (including enteroscopy) was unsuccessful in identifying a bleeding source. After repeat capsule endoscopy at our center confirmed bleeding in the distal small bowel, CT angiography identified a 6-mm focal area of enhancement in the ileum communicating with a distal branch of the superior mesenteric artery. Direct visceral angiography with super-selective arteriography identified a fast-flow vascular malformation supplied by terminal branches of the ileal artery. Diagnostic laparoscopy revealed intra-abdominal adhesions and no clear vascular malformation. Initial careful visual and manual examination of the bowel after conversion to laparotomy failed to identify the lesion. On-table retrograde enteroscopy demonstrated a small, pulsatile lesion without ulceration or adherent clot in the mucosa of the proximal ileum. With endoscopic transillumination, a cluster of serpiginous vessels could be seen within the wall of the small bowel. The lesion was resected and pathology was consistent with angiodysplasia. Angiodysplasia is a rare cause of occult, chronic gastrointestinal bleeding in children. A multidisciplinary approach optimizes the likelihood of therapeutic success.http://www.sciencedirect.com/science/article/pii/S2213576616301932AngiodysplasiaArteriovenous malformationGastrointestinal bleeding |
| spellingShingle | Andrew Jackson Murphy Anna P. Lillis Harry P. Kozakewich Ahmad I. Alomari Heung Bae Kim Victor L. Fox Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy Journal of Pediatric Surgery Case Reports Angiodysplasia Arteriovenous malformation Gastrointestinal bleeding |
| title | Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy |
| title_full | Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy |
| title_fullStr | Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy |
| title_full_unstemmed | Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy |
| title_short | Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy |
| title_sort | ileal angiodysplasia causing chronic occult gastrointestinal bleeding in a 14 year old boy |
| topic | Angiodysplasia Arteriovenous malformation Gastrointestinal bleeding |
| url | http://www.sciencedirect.com/science/article/pii/S2213576616301932 |
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