Colonic angiodysplasia on CT colonography: case report and characteristic imaging findings

Inferior mesenteric arteriovenous malformation extending to splenic flexure colonic wall presenting with massive lower gastrointestinal bleeding, a case report

INTRODUCTION AND IMPORTANCE

An arteriovenous malformation (AVM) in the inferior mesenteric artery is a rare vascular pathology that accounts for 6 % of the causes of gastrointestinal bleeding. AVMs are typically classified as congenital persisting embryonic vasculature that link both systems and do not develop into arteries or veins [3], but they may also develop later in life. The majority of documented cases are iatrogenic after colon surgery.

CASE PRESENTATION

Herein we describe a 56-year-old man who presented complaining of fresh blood per rectum with passage of clots not related to defecation with no previous similar episodes, he was found to have extensive inferior mesenteric branches AVM invading the colonic splenic flexure via Computed Tomography (CT) angiography following three non-revealing upper and lower endoscopies which was later managed surgically with left hemicolectomy with primary end to end colo-colic anastomosis.

CLINICAL DISCUSSION

Although AVMs seldom manifest in multiple sites through the gastrointestinal tract, it is more prevalent in the stomach, small intestine, and ascending colon, and very unusual to affect the Inferior mesenteric artery and vein and to extend to the splenic flexure colonic wall.

CONCLUSION

Even if rare, inferior mesenteric AVMs should be suspected in a patient presenting with GI Bleeding with unrevealing endoscopies, where CT Angiography is to be considered.

Massive lower gastrointestinal bleeding in a young postpartum lady: A management dilemma

Introduction: Lower gastrointestinal (GI) bleeding secondary to bleeding colonic angiodysplasia in a young population is rare. The prevalence of angiodysplasia in healthy asymptomatic adult was 0.8% and increases in elderly population, chronic renal failure, pulmonary disease, aortic stenosis, and von Willebrand disease. Aim: We are reporting a case of a young, postpartum woman who presented to us with massive lower GI bleeding secondary to bleeding angiodysplasia. Angiodysplasia is rare in this group of patients, making the detection and treatment challenging. Case study: A fit 25-year-old woman presented with type IV hypovolemic shock due to massive lower GI bleeding on postpartum day 15. Emergency colonoscopy was attempted with no evidence of active bleeding detected until splenic flexure. The patient was rushed to the operation theatre for exploratory laparotomy due to unstable condition. Segmental colonic clamping was performed and due to persistent blood pooling at different segments throughout the colon, subtotal colectomy and end ileostomy were performed. Patient recovered well post-operatively. Results and discussion: Physiological changes during pregnancy may has aggravated the risk of bleeding in GI angiodysplasia. Following resuscitation, a lesion causing lower GI bleed can be identified and treated with a variety of endoscopic procedures, radiological and surgical interventions. In our case, the role of surgery comes in place due to massive life-threatening lower GI bleeding not responding to resuscitation. Conclusions: Postpartum gastrointestinal bleeding from multiple colonic angiodysplasia is rare. It poses a challenge in diagnostic and treatment strategies. A timely individualized intervention either via endoscopy, interventional radiology or surgery is crucial and life-saving.

Hemosuccus pancreatitis due to a ruptured splenic artery pseudoaneurysm - diagnosis and endovascular management

Hemosuccus pancreatitis is a rare and potentially fatal cause of upper gastrointestinal bleeding characterized by hemorrhage from the ampulla of Vater via the pancreatic duct. In this case, a patient with chronic pancreatitis on a background of chronic alcoholism is found to have a splenic artery pseudoaneurysm that was bleeding into the pancreatic duct. This was identified on contrast-enhanced computed tomography imaging and successfully managed via microcoil embolization.