eMedicine Specialties > Gastroenterology > Colon

Angiodysplasia of the Colon: Differential Diagnoses & Workup

Author: Alan BR Thomson, MD, MSc, PhD, Professor, Department of Medicine, Division of Gastroenterology, University of Alberta Faculty of Medicine
Coauthor(s): Andrea Duchini, MD, Assistant Professor of Medicine, Associate Medical Director of Liver Transplantation, Division of Transplantation, Department of Surgery, The Methodist Hospital-Cornell University, Houston; John Godino, MD, Staff Physician, Department of Internal Medicine, Brooke Army Medical Center; Peter Wong, MD, Director of Gastroenterology Clinical Service/Manometry and Physiology, Brooke Army Medical Center; Assistant Professor, Department of Medicine, Division of Gastroenterology, University of Texas Health Science Center at San Antonio
Contributor Information and Disclosures

Updated: May 27, 2009

Differential Diagnoses

Colon Cancer, Adenocarcinoma
Portal Hypertension
Colonic Polyps
Rectal Cancer
Diverticulitis
Hemorrhoids
Metastatic Cancer, Unknown Primary Site

Other Problems to Be Considered

  • Anorectal fissures
  • Diverticulosis
  • Enterocolitis (ischemic, infectious, inflammatory bowel, radiation-induced)

Workup

Laboratory Studies

  • Complete blood cell (CBC) count: Approximately 10% of patients who bleed from angiodysplasia present with anemia.
  • Serum iron level: Iron deficiency is found in 10% of patients with bleeding angiodysplasia.
  • Stool for occult blood: As many as 15% of patients with bleeding angiodysplasia will be intermittently positive for occult blood.
  • See the algorithm for acute GI bleeding in Image 1 or below.
    Algorithm for acute gastrointestinal (GI) bleedin...

    Algorithm for acute gastrointestinal (GI) bleeding. CBC = complete blood cell count; CXR = chest x-ray; EKG = electrocardiography; IVF = intravenous fluid; NG = nasogastric.

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    Algorithm for acute gastrointestinal (GI) bleedin...

    Algorithm for acute gastrointestinal (GI) bleeding. CBC = complete blood cell count; CXR = chest x-ray; EKG = electrocardiography; IVF = intravenous fluid; NG = nasogastric.

Imaging Studies

  • Selective mesenteric angiography is a useful diagnostic technique for angiodysplasias, especially in patients with massive bleeding in whom a colonoscopic diagnosis is difficult.
    • The sensitivity of angiography ranges from 58% to 86%. Detection of bleeding depends on the rate of bleeding (as low as 0.5 mL/min), technique, and timing of angiography in relation to the period of bleeding.
    • The above 3 angiographic signs correspond to the development of ectatic changes in vascular lesions. Their prevalence has been recorded less systematically in other parts of the intestinal tract. However, the interpreter must consider all clinical information, because these angiographic findings may be observed in other disorders, such as malignancy.
      • The most frequent and earliest angiographic sign is a densely opacified, dilated, and slowly emptying draining vein within the intestinal wall. This vein is detected during the venous phase of the study and is present in more than 90% of angiodysplastic lesions.
      • As the lesion progresses, a vascular tuft may become apparent during the arterial phase of the study. This is observed in as many as 70-80% of patients with angiodysplasia. It represents an extension of the dilation process to the mucosal venules.
      • The latest sign, an early-filling vein, may be observed in the arterial phase, indicating a more developed arteriovenous communication through the angiodysplastic lesion. It is observed in only 60-70% of cases of angiodysplasia.
      • Demonstration of extravasation of contrast dye in the bowel lumen from angiodysplastic lesions is definite evidence of bleeding; however, this is observed in only 6-20% of patients. This low percentage is attributed to the episodic nature of bleeding lesions.
  • Angiography of resected specimens has been used to confirm appropriate resection when preoperative studies are equivocal or unsatisfactory. An intraluminal formalin fixation technique on the resected specimen, followed by mucosal dissection, has also been used for documenting correct resection. Vasopressin infusion during angiography can arrest bleeding, but potential complications of vasopressin include bowel infarction, arterial vasospasm, and lower extremity ischemia.
  • Radionuclide scanning using technetium-99m (99m Tc)–labeled red blood cells or99m Tc sulfur colloid is helpful in detecting and localizing active bleeding from angiodysplasia. Scanning can detect bleeding with rates as low as 0.1 mL/min. The intermittent bleeding nature of angiodysplasia has limited the utility of radionuclide studies in this disorder.
    • Red blood cells that are labeled with technetium have a long half-life in the intravascular compartment and are especially useful in patients with intermittent hemorrhage. The usefulness of technetium-labeled red blood cells is attributed to the ability to detect bleeding during the 12 or so hours after a single injection of radiolabeled cells.
    • The reticuloendothelial system rapidly clears99m Tc sulfur colloid.99m Tc sulfur colloid has a half-life of only 3 minutes; hence, it is helpful only in patients with active bleeding. The extravasated labeled sulfur colloid easily demonstrates the site of bleeding in the absence of confusing background activity in the circulation, although uptake into the liver and spleen restricts the image area.
    • Nuclear scans lack the specificity of an angiogram in differentiating the nature of bleeding lesions, despite the fact that they are noninvasive and relatively easy to perform. Nuclear scans have proven more useful as an adjunct to angiography by localizing and confirming the presence of bleeding, minimizing the number of angiograms that do not yield meaningful diagnostic information, and allowing rapid selection of the artery to be injected by angiography. Confirm positive findings from a radionuclide study by colonoscopy or angiography if surgical resection is contemplated.
      Angiodysplasia identified on cecum wall during co...

      Angiodysplasia identified on cecum wall during colonoscopy.

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      Angiodysplasia identified on cecum wall during co...

      Angiodysplasia identified on cecum wall during colonoscopy.

  • Helical computed tomography (CT) angiography can detect extravasation from angiodysplasia and is potentially an important noninvasive test in patients with obscure bleeding sites.
  • Capsule endoscopy has been reported to detect cecal angiodysplasias in selected cases. Capsule endoscopy is particularly useful to demonstrate small intestinal lesions, but its role as a diagnostic test for the colon is still experimental.26
  • Double-balloon endoscopy is useful to detect small bowel lesions, and retrograde double-balloon endoscopy may allow for careful inspection of the cecum and ileocecal valve.27,28

Other Tests

  • Air contrast barium enema is not recommended during acute GI bleeding. Air contrast barium enemas can help exclude other causes of chronic colonic bleeding; however, they are not useful in detecting angiodysplasia, because the lesions are small and usually do not distort the colonic mucosa. In addition, barium enema can obscure other diagnostic studies.

Procedures

  • Endoscopy is the most common method of diagnosing angiodysplasia in both the upper and lower GI tract.
    • Upper endoscopy is used to establish a diagnosis of gastric and duodenal angiodysplasia. Celiac artery and superior mesenteric artery arteriograms frequently fail to demonstrate these lesions, although large lesions with well-formed and enlarged draining veins have been reported in the gastric antrum. Angiography can demonstrate lesions in the more distal small intestine, a region less accessible to endoscopic evaluation. Push enteroscopy has proven to be a successful method of identifying angiodysplasia of the proximal small intestine in patients with obscure bleeding. Other methods of visually evaluating the small bowel are double-balloon enteroscopy, which is still investigational, and capsule enteroscopy, which is currently used in clinical practice.
    • The endoscopic appearance of gastric lesions typically has been described as discrete, flat, or slightly raised (2-10 mm) and bright red. These lesions have fernlike margins or stellate configurations. Proximal small intestinal lesions are the size of a pinpoint, with a similar gross appearance. A surrounding pale rim or halo also characterizes upper tract lesions.
    • Either angiography or colonoscopy may be used to detect colonic lesions. Because colonoscopy is a principal method in the evaluation of GI bleeding, diagnosis of these lesions often results from colonoscopic examination.
    • Comparative studies using selective angiography and colonoscopy indicate that the sensitivity of colonoscopy exceeds 80% when the lesions are located in the area examined by colonoscopy. Most angiodysplastic lesions are located in the right colon, thus, the entire colon must be examined. Angiography has the advantage of detecting additional angiodysplastic lesions not depicted by colonoscopy. In a series by Emanuel et al, 17% of subjects were found to have concomitant colonic and extracolonic angiodysplasia when studied by triple-vessel angiography.18 Angiography and colonoscopy can play important complementary roles.
    • Skibba et al first described the colonoscopic appearance of angiodysplasia in 1976.29 Angiodysplastic lesions are often described as discrete and small, with scalloped or frondlike edges and a visible draining vein. They can be flat or slightly raised and can be hidden within mucosal folds. Although angiodysplasia may be detected anywhere in the colon, a strong propensity exists for the cecum and ascending colon.
    • Angiodysplastic lesions encountered as incidental findings are generally small lesions with pale coloration compared with lesions with recent hemorrhage, which are described as extremely bright with elevated centers.
    • The endoscopic appearance of angiodysplasia can be confused with the ectasias associated with systemic diseases, such as hereditary hemorrhagic telangiectasia (HHT), Turner syndrome, Ehlers-Danlos syndrome, blue rubber web nevus syndrome, the CREST variant syndrome (calcinosis, Raynaud phenomenon, esophageal hypomotility, sclerodactyly, and telangiectasia) of scleroderma, gastric antral vascular ectasia (GAVE), portal hypertensive colopathy, and radiation-induced injury. The lack of systemic manifestations distinguishes angiodysplasia from these syndromes.
    • In addition, the endoscopic appearance of angiodysplasia may be difficult to discern from spider angiomata, radiation injury, ulcerative colitis (see Image 3 or below), Crohn disease (see Image 4 or below), ischemic colitis, and suction artifacts.
      Double-contrast barium enema studies in a 44-year...

      Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. These images show total colitis and extensive pseudopolyposis.

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      Double-contrast barium enema studies in a 44-year...

      Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. These images show total colitis and extensive pseudopolyposis.


      Double-contrast barium enema examination in a pat...

      Double-contrast barium enema examination in a patient with Crohn colitis demonstrates numerous aphthous ulcers.

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      Double-contrast barium enema examination in a pat...

      Double-contrast barium enema examination in a patient with Crohn colitis demonstrates numerous aphthous ulcers.

      Evaluation of a patient who may have angiodysplasia requires that the colonoscope be inserted carefully, with minimal use of suction, and that the mucosa be examined more carefully as the instrument is advanced than during withdrawal. Obtaining a biopsy of suspicious lesions may be necessary if classic features are not present.
    • Because blood pressure and volume influence the colonoscopic appearance of vascular lesions, angiodysplasia may not be evident in patients who have bled recently. Accurate evaluation of the colon may not be possible until effective fluid resuscitation and blood transfusions.
    • Some studies have noted that administering meperidine may diminish the prominence of some vascular abnormalities, and some researchers have advocated reversal by naloxone to aid in the accurate detection of these lesions.
  • Angiodysplasia can be detected infrequently by visual inspection of the serosal side of the bowel during laparotomy. Richardson et al made a correct diagnosis of angiodysplasia during surgical exploration in only 1 of 39 cases (2.6%).30 The remaining patients were diagnosed by angiography or colonoscopy. Fourteen of these individuals had undergone 21 nondiagnostic surgeries before their evaluation.
  • Intraoperative enteroscopy can help in localization of distal small bowel lesions. In addition, an angiographic catheter can be placed before surgery into the appropriate feeding vessel supplying the angiodysplastic lesion. The surgeon then can identify the catheter during surgery and explore and resect the appropriate small bowel segment.

Histologic Findings

Endoscopic forceps biopsy has revealed characteristic histopathologic features of angiodysplasia in only 31-60% of specimens. Endoscopic mucosal biopsies for purposes of diagnosis are generally not recommended because of the low diagnostic yield and the risk of provoking hemorrhage.
However, the histologic diagnosis of angiodysplasia is difficult. Acquired lesions such as angiodysplasias must be differentiated from vascular tumors, lesions associated with congenital or systemic disease, or radiation damage.
Angiodysplasias typically are irregularly shaped clusters of ectatic small arteries, small veins, and their capillary connections. They are more often multiple than single. Microscopically, angiodysplastic lesions are dilated, distorted, thin-walled vessels. The amount of smooth muscle in the vessel wall is variable. The vessel wall can become so thinned that it appears to be composed only of endothelium.

Markedly dilated submucosal vasculature is the most consistent abnormality and the earliest change identified. More advanced lesions involve the mucosa. Because the major portion of the lesion is often submucosal, endoscopic mucosal biopsies are often not diagnostic. Characteristic histopathologic findings of angiodysplasia are identified only in 31-60% of endoscopically obtained biopsies.

In addition, routine pathologic examination usually discovers less than one third of lesions. Injecting the colonic vasculature with silicone rubber and clearing the specimen can be used to identify almost all lesions. In this process, the rubber compound is injected through a catheter placed in one or more of the arteries supplying the colon, after which the specimen is refrigerated for 24 hours to allow the silicone to polymerize. Specimens are then dehydrated in increasing concentrations of ethyl alcohol and cleared with methyl salicylate. The result is a transparent specimen with a filled vascular bed, which is studied through a dissecting microscope using direct light as well as transillumination.

More on Angiodysplasia of the Colon

Overview: Angiodysplasia of the Colon
Differential Diagnoses & Workup: Angiodysplasia of the Colon
Treatment & Medication: Angiodysplasia of the Colon
Follow-up: Angiodysplasia of the Colon
Multimedia: Angiodysplasia of the Colon
References
Further Reading
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References

  1. Regula J, Wronska E, Pachlewski J. Vascular lesions of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2008;22(2):313-28. [Medline].

  2. Heyde EC. Gastrointestinal bleeding in aortic stenosis. N Engl J Med. 1958;259:196.

  3. Margulis AR, Heinbecker P, Bernard HR. Operative mesenteric arteriography in the search for the site of bleeding in unexplained gastrointestinal hemorrhage: a preliminary report. Surgery. Sep 1960;48:534-9. [Medline].

  4. Akhtar AJ, Shaheen MA, Zha J. Organic colonic lesions in patients with irritable bowel syndrome (IBS). Med Sci Monit. Sep 2006;12(9):CR363-7. [Medline].

  5. Clouse RE. Vascular lesions: ectasias, tumors, and malformations. In: Yamada T, Alpers DH, Laine L, Owyang C, Powell DW, eds. Textbook of Gastroenterology. Vol 2. 3rd ed. Philadelphia, Pa: JB Lippincott; 1999:2564-78.

  6. Ming SC, Goldman H. Vascular abnormalities of the gastrointestinal tract. In: Ming SC, Goldman H, eds. Pathology of the Gastrointestinal Tract. 2nd ed. Baltimore, Md: Williams & Wilkins Company; 1998:272-4.

  7. Mudhar HS, Balsitis M. Colonic angiodysplasia and true diverticula: is there an association?. Histopathology. Jan 2005;46(1):81-8. [Medline].

  8. Biss T, Hamilton P. Myelofibrosis and angiodysplasia of the colon: another manifestation of portal hypertension and massive splenomegaly?. J Clin Pathol. Sep 2004;57(9):999-1000. [Medline]. [Full Text].

  9. Schmidmaier R, Bittmann I, Gotzberger M, et al. Vascular ectasia of the whole intestine as a cause of recurrent gastrointestinal bleeding after high-dose chemotherapy. Endoscopy. Sep 2006;38(9):940-2. [Medline].

  10. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol. Apr 1995;90(4):564-7. [Medline].

  11. Rosborough TK, Swaim WR. Acquired von Willebrand's disease, platelet-release defect and angiodysplasia. Am J Med. Jul 1978;65(1):96-100. [Medline].

  12. Cass AJ, Bliss BP, Bolton RP, Cooper BT. Gastrointestinal bleeding, angiodysplasia of the colon and acquired von Willebrand's disease. Br J Surg. Sep 1980;67(9):639-41. [Medline].

  13. Duray PH, Marcal JM Jr, LiVolsi VA, et al. Gastrointestinal angiodysplasia: a possible component of von Willebrand's disease. Hum Pathol. Jun 1984;15(6):539-44. [Medline].

  14. Gostout CJ, Bowie EJW, Balm R, Fischer PK. Is angiodysplasia associated with von Willebrand's disease?. Gastroenterology. 1990;98:A172.

  15. Fressinaud E, Meyer D. International survey of patients with von Willebrand disease and angiodysplasia. Thromb Haemost. Sep 1 1993;70(3):546. [Medline].

  16. Makris M. Gastrointestinal bleeding in von Willebrand disease. Thromb Res. 2006;118 suppl 1:S13-7. [Medline].

  17. Hirri HM, Green PJ, Lindsay J. Von Willebrand's disease and angiodysplasia treated with thalidomide. Haemophilia. May 2006;12(3):285-6. [Medline].

  18. Emanuel RB, Weiser MM, Shenoy SS, Satchidanand SK, Asirwatham J. Arteriovenous malformations as a cause of gastrointestinal bleeding: the importance of triple-vessel angiographic studies in diagnosis and prevention of rebleeding. J Clin Gastroenterol. Jun 1985;7(3):237-46. [Medline].

  19. Schwartz J, Rozenfeld V, Habot B. Cessation of recurrent bleeding from gastrointestinal angiodysplasia, after beta blocker treatment in a patient with hypertrophic subaortic stenosis--a case history. Angiology. Mar 1992;43(3 pt 1):244-8. [Medline].

  20. Pate GE, Chandavimol M, Naiman SC, Webb JG. Heyde's syndrome: a review. J Heart Valve Dis. Sep 2004;13(5):701-12. [Medline].

  21. Ueno S, Nakase H, Kasahara K, et al. Clinical features of Japanese patients with colonic angiodysplasia. J Gastroenterol Hepatol. Aug 2008;23(8 pt 2):e363-6. [Medline].

  22. Imperiale TF, Ransohoff DF. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature. Gastroenterology. Dec 1988;95(6):1670-6. [Medline].

  23. Kaaroud H, Fatma LB, Beji S, et al. Gastrointestinal angiodysplasia in chronic renal failure. Saudi J Kidney Dis Transpl. Sep 2008;19(5):809-12. [Medline]. [Full Text].

  24. Roskell DE, Biddolph SC, Warren BF. Apparent deficiency of mucosal vascular collagen type IV associated with angiodysplasia of the colon. J Clin Pathol. Jan 1998;51(1):18-20. [Medline]. [Full Text].

  25. Junquera F, Saperas E, de Torres I, Vidal MT, Malagelada JR. Increased expression of angiogenic factors in human colonic angiodysplasia. Am J Gastroenterol. Apr 1999;94(4):1070-6. [Medline].

  26. Kovacs M, Pak P, Pak G, Feheer J, Huttl K. [Multiple angiodysplasias diagnosed by capsule endoscopy] [Hungarian]. Orv Hetil. Dec 23 2007;148(51):2435-40. [Medline].

  27. Jarbandhan S, van der Veer WM, Mulder CJ. Double-balloon endoscopy in the diagnosis and treatment of hemorrhage from retrovalvular angiodysplasias. J Gastrointestin Liver Dis. Sep 2008;17(3):333-4. [Medline]. [Full Text].

  28. Monkemuller K, Fry LC, Neumann H, Rickes S, Malfertheiner P. [Diagnostic and therapeutic utility of double balloon endoscopy: experience with 225 procedures] [Spanish]. Acta Gastroenterol Latinoam. Dec 2007;37(4):216-23. [Medline].

  29. Skibba RM, Hartong WA, Mantz FA, Hinthorn DR, Rhodes JB. Angiodysplasia of the cecum: colonoscopic diagnosis. Gastrointest Endosc. Feb 1976;22(3):177-9. [Medline].

  30. Richardson JD, Max MH, Flint LM Jr, et al. Bleeding vascular malformations of the intestine. Surgery. Sep 1978;84(3):430-6. [Medline].

  31. Suzuki N, Arebi N, Saunders BP. A novel method of treating colonic angiodysplasia. Gastrointest Endosc. Sep 2006;64(3):424-7. [Medline].

  32. Hurlstone DP, Karageh M, Sanders DS. The Olympus EVIS LUCERA variable indices of haemoglobin chart function: a novel technique for establishing the completeness of vascular mucosal ablation in colonic angiodysplasia. Endoscopy. Jan 2006;38(1):102. [Medline]. [Full Text].

  33. Vakil N, Huilgol V, Khan I. Effect of push enteroscopy on transfusion requirements and quality of life in patients with unexplained gastrointestinal bleeding. Am J Gastroenterol. Mar 1997;92(3):425-8. [Medline].

  34. Pishvaian AC, Lewis JH. Use of endoclips to obliterate a colonic arteriovenous malformation before cauterization. Gastrointest Endosc. May 2006;63(6):865-6. [Medline].

  35. Polese L, Angriman I, Pagano D, et al. Laser therapy and surgical treatment in transfusion-dependent patients with upper-gastrointestinal vascular ectasia. Lasers Med Sci. Sep 2006;21(3):140-6. [Medline].

  36. Meyer CT, Troncale FJ, Galloway S, Sheahan DG. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine (Baltimore). Jan 1981;60(1):36-48. [Medline].

  37. Lewis BS, Salomon P, Rivera-MacMurray S, et al. Does hormonal therapy have any benefit for bleeding angiodysplasia?. J Clin Gastroenterol. Sep 1992;15(2):99-103. [Medline].

  38. Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH. Angiodysplasia. Clinical presentation and colonoscopic diagnosis. Dig Dis Sci. Jun 1984;29(6):481-5. [Medline].

  39. Alavi A, Ring EJ. Localization of gastrointestinal bleeding: superiority of 99mTc sulfur colloid compared with angiography. AJR Am J Roentgenol. Oct 1981;137(4):741-8. [Medline]. [Full Text].

  40. Alvarez L, Puleo J, Balint JA. Investigation of gastrointestinal bleeding in patients with end stage renal disease. Am J Gastroenterol. Jan 1993;88(1):30-3. [Medline].

  41. Apostolakis E, Doering C, Kantartzis M, Winter J, Schulte HD. Calcific aortic-valve stenosis and angiodysplasia of the colon: Heyde's syndrome--report of two cases. Thorac Cardiovasc Surg. Dec 1990;38(6):374-6. [Medline].

  42. Bhutani MS, Gupta SC, Markert RJ, et al. A prospective controlled evaluation of endoscopic detection of angiodysplasia and its association with aortic valve disease. Gastrointest Endosc. Nov 1995;42(5):398-402. [Medline].

  43. Boley SJ, Sammartano R, Adams A, et al. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology. Apr 1977;72(4 pt 1):650-60. [Medline].

  44. Boley SJ, Sprayregen S, Sammartano RJ, Adams A, Kleinhaus S. The pathophysiologic basis for the angiographic signs of vascular ectasias of the colon. Radiology. Dec 1977;125(3):615-21. [Medline].

  45. Brandt LJ, Mukhopadhyay D. Masking of colon vascular ectasias by cold water lavage. Gastrointest Endosc. Jan 1999;49(1):141-2. [Medline].

  46. Britt LG, Warren L, Moore OF 3rd. Selective management of lower gastrointestinal bleeding. Am Surg. Mar 1983;49(3):121-5. [Medline].

  47. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. Nov 1986;204(5):530-6. [Medline]. [Full Text].

  48. Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol. Nov 1996;91(11):2329-32. [Medline].

  49. Chou CC, Dabney JM. Interrelation of ileal wall compliance and vascular resistance. Am J Dig Dis. Dec 1967;12(12):1198-208. [Medline].

  50. Cottone C, Disclafani G, Genova G, et al. Use of BICAP in a case of colon angiodysplasia. Surg Endosc. 1991;5(2):99-100. [Medline].

  51. Duchini A, Sessoms SL. Gastrointestinal hemorrhage in patients with systemic sclerosis and CREST syndrome. Am J Gastroenterol. Sep 1998;93(9):1453-6. [Medline].

  52. Ettorre GC, Francioso G, Garribba AP, et al. Helical CT angiography in gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol. Mar 1997;168(3):727-31. [Medline]. [Full Text].

  53. Flynn CT, Chandran PK. Renal failure and angiodysplasia of the colon. Ann Intern Med. Jul 1985;103(1):154. [Medline].

  54. Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol. Jun 1993;88(6):807-18. [Medline].

  55. Foutch PG. Colonic angiodysplasia. Gastroenterologist. Jun 1997;5(2):148-56. [Medline].

  56. Ghosh J, Speake D, Benbow EW, Watson AJ. Co-existence of true colonic diverticula with angiodysplasia. Colorectal Dis. Sep 2005;7(5):530-2. [Medline].

  57. Greason KL, Acosta JA, Magrino TJ, Choe M. Angiodysplasia as the cause of massive lower gastrointestinal hemorrhage in a young adult. Report of a case. Dis Colon Rectum. Jun 1996;39(6):702-4. [Medline].

  58. Gupta N, Longo WE, Vernava AM 3rd. Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively. Dis Colon Rectum. Sep 1995;38(9):979-82. [Medline].

  59. Hemingway AP. Angiodysplasia as a cause of iron deficiency anaemia. Blood Rev. Sep 1989;3(3):147-51. [Medline].

  60. Ho S, Jackson J. The angiographic diagnosis of colonic carcinoma. Clin Radiol. May 1998;53(5):345-9. [Medline].

  61. Hochter W, Weingart J, Kuhner W, Frimberger E, Ottenjann R. Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency. Endoscopy. Sep 1985;17(5):182-5. [Medline].

  62. Howard OM, Buchanan JD, Hunt RH. Angiodysplasia of the colon. Experience of 26 cases. Lancet. Jul 3 1982;2(8288):16-9. [Medline].

  63. Katsinelos P, Paroutoglou G, Beltsis A, et al. Recurrent colonic Dieulafoy's lesion associated with bizarre vascular malformations and abnormal von Willebrand factor. Acta Gastroenterol Belg. Oct-Dec 2005;68(4):443-5. [Medline].

  64. Kheterpal S. Angiodysplasia: a review. J R Soc Med. Oct 1991;84(10):615-8. [Medline]. [Full Text].

  65. Kitiyakara T, Selby W. Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding. Gastrointest Endosc. Aug 2005;62(2):234-8. [Medline].

  66. Krevsky B. Detection and treatment of angiodysplasia. Gastrointest Endosc Clin N Am. Jul 1997;7(3):509-24. [Medline].

  67. Moparty B, Raju GS. Role of hemoclips in a patient with cecal angiodysplasia at high risk of recurrent bleeding from antithrombotic therapy to maintain coronary stent patency: a case report. Gastrointest Endosc. Sep 2005;62(3):468-9. [Medline].

  68. Noer RJ, Derr JW. Effect of distention on intestinal revascularization. Arch Surg. Sep 1949;59(3):542-9. [Medline].

  69. Orsi P, Guatti-Zuliani C, Okolicsanyi L. Long-acting octreotide is effective in controlling rebleeding angiodysplasia of the gastrointestinal tract. Dig Liver Dis. May 2001;33(4):330-4. [Medline].

  70. Potter GD, Sellin JH. Lower gastrointestinal bleeding. Gastroenterol Clin North Am. Jun 1988;17(2):341-56. [Medline].

  71. Reinus JF, Brandt LJ. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding. Gastroenterol Clin North Am. Mar 1994;23(1):1-20. [Medline].

  72. Roberts PL, Schoetz DJ Jr, Coller JA. Vascular ectasia. Diagnosis and treatment by colonoscopy. Am Surg. Jan 1988;54(1):56-9. [Medline].

  73. Sabanathan S, Nag SB. Angiodysplasia of the colon: a post-mortem study. J R Coll Surg Edinb. Sep 1982;27(5):285-91. [Medline].

  74. Scheffer SM, Leatherman LL. Resolution of Heyde's syndrome of aortic stenosis and gastrointestinal bleeding after aortic valve replacement. Ann Thorac Surg. Oct 1986;42(4):477-80. [Medline].

  75. Semba T, Fujii Y. Relationship between venous flow and colonic peristalsis. Jpn J Physiol. Aug 1970;20(4):408-16. [Medline].

  76. Serin E, Paydas S, Yildizer K, Seyrek N, Sagliker Y. von Recklinghausen's disease associated with angiodysplasia of colon and end-stage renal disease. Nephron. 1995;71(2):243. [Medline].

  77. Sharma R, Gorbien MJ. Angiodysplasia and lower gastrointestinal tract bleeding in elderly patients. Arch Intern Med. Apr 24 1995;155(8):807-12. [Medline].

  78. Szilagyi A, Ghali MP. Pharmacological therapy of vascular malformations of the gastrointestinal tract. Can J Gastroenterol. Mar 2006;20(3):171-8. [Medline]. [Full Text].

  79. Tedesco FJ, Waye JD, Raskin JB, Morris SJ, Greenwald RA. Colonoscopic evaluation of rectal bleeding: a study of 304 patients. Ann Intern Med. Dec 1978;89(6):907-9. [Medline].

  80. Thelmo WL, Vetrano JA, Wibowo A, et al. Angiodysplasia of colon revisited: pathologic demonstration without the use of intravascular injection technique. Hum Pathol. Jan 1992;23(1):37-40. [Medline].

  81. Welch CE, Athanasoulis CA, Galdabini JJ. Hemorrhage from the large bowel with special reference to angiodysplasia and diverticular disease. World J Surg. Jan 1978;2(1):73-83. [Medline].

  82. Wright HK, Pelliccia O, Higgins EF Jr, Sreenivas V, Gupta A. Controlled, semielective, segmental resection for massive colonic hemorrhage. Am J Surg. Apr 1980;139(4):535-8. [Medline].

  83. Zuckerman G, Benitez J. A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding. Am J Gastroenterol. Jan 1992;87(1):62-6. [Medline].

  84. Zuckerman GR, Cornette GL, Clouse RE, Harter HR. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med. May 1985;102(5):588-92. [Medline].

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Further Reading

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Keywords

angiodysplasia of the colon, colonic angiodysplasia, angiodysplasia, arteriovenous malformation, AVM, angiomatosis, vascular ectasia, hemangioma, telangiectasia, vascular lesion of the gastrointestinal tract, gastrointestinal bleeding, GI bleeding, GI hemorrhage, gastrointestinal hemorrhage, rectal bleeding, blood in stool, colonoscopy

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Contributor Information and Disclosures

Author

Alan BR Thomson, MD, MSc, PhD, Professor, Department of Medicine, Division of Gastroenterology, University of Alberta Faculty of Medicine
Alan BR Thomson, MD, MSc, PhD is a member of the following medical societies: American Federation for Aging Research, American Federation for Clinical Research, American Gastroenterological Association, American Geriatrics Society, American Physiological Society, Canadian Association of Gastroenterology, Gastroenterology Research Group, New York Academy of Sciences, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Andrea Duchini, MD, Assistant Professor of Medicine, Associate Medical Director of Liver Transplantation, Division of Transplantation, Department of Surgery, The Methodist Hospital-Cornell University, Houston
Andrea Duchini, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and International Liver Transplantation Society
Disclosure: Nothing to disclose.

John Godino, MD, Staff Physician, Department of Internal Medicine, Brooke Army Medical Center
John Godino, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Peter Wong, MD, Director of Gastroenterology Clinical Service/Manometry and Physiology, Brooke Army Medical Center; Assistant Professor, Department of Medicine, Division of Gastroenterology, University of Texas Health Science Center at San Antonio
Peter Wong, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Marco G Patti, MD, Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine
Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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