Ileal angiodysplasia causing chronic, occult gastrointestinal bleeding in a 14-year-old boy

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• 作者：Andrew Jackson Murphy^a ; ^{Andrew.murphy@stjude.org} ; Anna P. Lillis^b ; ^{Anna.lillis@childrens.harvard.edu} ; Harry P. Kozakewich^c ; ^{Harry.kozakewich@childrens.harvard.edu} ; Ahmad I. Alomari^b ; ^{Ahmad.alomari@childrens.harvard.edu} ; Heung Bae Kim^d ; ^{Heung.kim@childrens.harvard.edu} ; Victor L. Fox^e ; ^{Victor.fox@childrens.harvard.edu}
• 关键词：Angiodysplasia ; Arteriovenous malformation ; Gastrointestinal bleeding
• 刊名：Journal of Pediatric Surgery Case Reports
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：16
• 期：Complete
• 页码：46-49
• 全文大小：1573 K
• 卷排序：16

文摘

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.