Makindo Medical Notes

Treatment is usually not advocated for asymptomatic patients when angiodysplasias are found incidentally.

About

• A vascular anomaly that becomes more common with age.

Associations

• Osler-Weber-Rendu syndrome
• Severe calcific aortic stenosis: Shearing of von Willebrand factor leads to acquired von Willebrand disease (Heyde syndrome).

Aetiology

• Colonic bleeding often originates from the caecum and right colon, specifically on the antimesenteric border.
• Associated with aging and increased vessel fragility.
• Characterized by ectatic, dilated, thin-walled vessels lined by endothelium, with or without small amounts of smooth muscle.

Clinical

• Presentation includes gastrointestinal bleeding and anaemia.
• Symptoms may include anaemia-related fatigue, and in severe cases, bleeding per rectum (PR).
• Typically seen in frail, elderly patients.

Investigations

• Blood tests: FBC, U&E, ESR, clotting, B12, folate, and ferritin levels.
• OGD and colonoscopy to identify potential lesions.
• Small bowel enteroscopy for upper small bowel evaluation.
• Capsule endoscopy may be considered for complete small bowel assessment.
• Angiography in cases with significant bleeding (≥1.5 ml/min); early venous enhancement may indicate an AVM.

Pathology

• Consider differential diagnoses such as colorectal cancer or diverticulitis.

Management

• Local treatment at colonoscopy with cautery or argon plasma coagulation (APC) if needed.
• Evaluate and adjust antithrombotic or anticoagulant therapy based on bleeding risk.
• Supportive management with blood transfusion or iron infusion as needed.
• Angiography with potential embolisation for severe, refractory bleeding.
• Medications such as tranexamic acid or estrogen may be considered in some cases.
• Surgical resection of the bleeding segment may be warranted in severe disease.

References

• Reference sources related to angiodysplasias and gastrointestinal bleeding.