Angiodysplasia
Related Subjects:
|Rectal Prolapse
|Anal Cancer
|Anal Fissure
|Pilonidal Abscess (sinus)
|Haemorrhoids (Piles)
|Angiodysplasia
|Hartmann's procedure
Angiodysplasias are fragile vascular malformations of the bowel wall, often found incidentally. 👉 Treatment is not usually required if the patient is asymptomatic. Symptomatic cases present with bleeding and anaemia.
📖 About
- Acquired vascular anomaly of the gastrointestinal tract, increasing in prevalence with age.
- Most commonly affects the caecum and right colon (antimesenteric border).
- Important cause of lower GI bleeding in elderly patients 👵👴.
🔗 Associations
- Osler-Weber-Rendu syndrome (hereditary haemorrhagic telangiectasia).
- Heyde syndrome: Severe calcific aortic stenosis → shear stress damages von Willebrand factor → acquired vWF disease → predisposes to bleeding. ❤️🩸
🧬 Aetiology & Pathology
- Age-related degeneration of submucosal veins and venules → thin-walled, dilated, ectatic vessels prone to rupture.
- Histology: Endothelial-lined channels ± smooth muscle.
- Bleeding usually occurs intermittently and can be occult or overt.
👩⚕️ Clinical Features
- Iron-deficiency anaemia → fatigue, pallor, dyspnoea on exertion.
- Intermittent GI bleeding (may be occult or frank PR bleeding).
- Typically seen in frail elderly patients; bleeding may be chronic, recurrent, and difficult to localise.
🔎 Investigations
- Bloods: FBC (microcytic anaemia), U&E, clotting, ferritin, B12, folate.
- OGD + Colonoscopy: First-line to rule out malignancy/diverticulitis and identify angiodysplasias.
- Capsule endoscopy: Useful for small bowel lesions.
- Angiography: Detects active bleeding (>1.5 ml/min); may show early venous filling.
- Differentials: Colorectal cancer, diverticulitis, haemorrhoids.
💊 Management
- Asymptomatic: No treatment required.
- Endoscopic therapy: Argon plasma coagulation (APC) or cautery at colonoscopy for bleeding lesions.
- Optimise medications: Review and balance anticoagulation/antiplatelet therapy.
- Supportive: Iron supplementation, IV iron, or blood transfusion for anaemia.
- Radiological: Angiographic embolisation for refractory bleeding.
- Medical therapy: Tranexamic acid, thalidomide, or oestrogen-progesterone therapy in select cases.
- Surgery: Segmental colectomy for localised, severe, or recurrent bleeding not controlled by other means.
📚 References
