An unusual presentation of angiodysplasia of small bowel

Clinical History

51-year-old male patient with no co morbidities presented with chronic anaemia. His upper and lower GI endoscopy were normal.

Imaging Findings

On CT examination of abdomen, there were multiple enhancing well defined lesions seen in walls of jejunal and ileal loops. The portal vein was dilated.

Discussion

Angiodysplasias are ecstatic blood vessels seen in the mucosa and submucosa of the GI tract.
Small bowel angiodysplasia is a rare entity that causes lower intestinal bleeding. The diagnosis is difficult and usually based on selective angiogram performed during an episode of haemorrhage when other techniques such as intestinal enema and endoscopic examination show negative results. [1]

Gastrointestinal angioysplasia are vascular malformations that can be inherited or acquired. These can be located in the stomach (gastric antral vascular ectasia), showing the appearance of watermelon mucosa or bowel. The most frequently affected are colon and terminal ileum.
This patient was found in the jejunum and ileum. The pathogenesis is unclear. The angiodysplasia is covered by endothelium and smooth muscles are limited so they are very fragile.
Angiodysplasia has been implicated in association with several systemic diseases including atherosclerotic cardiovascular disease, aortic stenosis, chronic renal disease, collagen vascular disease, von Willebrand's disease, chronic obstructive pulmonary disease, and cirrhosis of the liver. [3, 4, 5, 6]

In 70% of patients the lesions are multiple. The bleeding is self-limiting in 90% of cases but can be life threatening.
For investigation.
Capsule endoscopy, contrast enhanced CT and RBC labelled scan are very helpful in diagnosing these lesions.

Usually, in the treatment of patients with gastrointestinal haemorrhage, the arteriography plays an important role in detecting the localisation of bleeding. [7, 8]
This patient presented with chronic anaemia which did not respond to therapy. As with this particular case we recommend total transplantation of small bowel.
Angiodysplasias of small bowel can be obscure with use of positive oral contrast, so one should use negative contrast i.e. water with intravenous contrast and it will readily show the lesions and make it clearer.

Differential Diagnosis List

Final Diagnosis

Diffuse angiodysplasia of small bowel

URL:	https://www.eurorad.org/case/9978
DOI:	10.1594/EURORAD/CASE.9978
ISSN:	1563-4086