Large Intestine: Vascular Malformations

Angiodysplasia (Arteriovenous Malformation/AVM)

Basics

  • Also Called Angiectasia or Vascular Ectasia
  • Abnormal Ectatic, Dilated & Thin-Walled Blood Vessels of the GI Tract
  • Most Common Vascular Anomaly of the GI Tract
  • Most Common Cause of Obscure Bleeding (Persistent with No Known Source)
  • Most Common Site: Right Colon
  • Causes Venous Bleeding
  • Associated with: ESRD, Von Willebrand Disease & Aortic Stenosis
    • May Show Improvement After Valve Replacement

Diagnosis

  • Dx: Endoscopy
  • Angiogram Shows: Slow Emptying & Tufts

Treatment

  • Incidental: None
  • Bleeding: Endoscopic (Clips or Coagulation)
    • May Consider Observation if Bleeding is Occult (Controversial)
    • If Fails: Angiography or Surgical Resection
    • Alternatives if Refractory: Octreotide or Thalidomide

Angiodysplasia 1

Dieulafoy’s Lesion (Calibre Persistent Artery)

Basics

  • Large Tortuous Submucosal Arteriole That Can Erode/Bleed
  • Risk for Spontaneous Rupture & Significant Bleeding

Location

  • Most Common Site: Stomach
  • Second Most Common Site: Duodenum
  • Can Be Anywhere Along the GI Tract

Diagnosis

  • Dx: Endoscopy
  • May Be Seen on Angiography or Tagged RBC Scan

Treatment

  • Primary Tx: Endoscopic (Clips, Epinephrine Injection or Coagulation)
  • If Fails: Angioembolization or Surgical Resection

Dieulafoy’s Lesion of Colon 2

References

  1. Guntau J. Wikimedia Commons. (License: CC BY-SA-3.0)
  2. Ma C, Hundal R, Cheng EJ. Colonic Dieulafoy’s Lesion: A Rare Cause of Lower Gastrointestinal Hemorrhage and Review of Endoscopic Management. Case Rep Gastrointest Med. 2014;2014:436293. (License: CC BY-3.0)