Angiodysplasia of the Colon Clinical Presentation

Updated: May 08, 2019
  • Author: Hussein Al-Hamid, MD; Chief Editor: BS Anand, MD  more...
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Presentation

History

Many patients with angiodysplasia are asymptomatic, and the lesions are found incidentally, such as with screening colonoscopy. Clinical presentation and physical examination are related to GI bleeding or its consequences.

The estimated incidence of active GI bleed in patients with angiodysplasia is less than 10%. However, because these lesions may be located throughout the GI tract and because the rate of bleeding may be variable, the clinical presentation ranges from hematemesis or hematochezia to occult anemia. Bleeding is usually chronic or recurrent and, in most cases, low grade and painless because of the venous source.

Angiodysplastic lesions are often present in more than one location within the GI tract, and the presentation may vary during a patient's clinical course.

GI bleeding from small bowel lesions has occurred in as many as 22% of patients in whom angiodysplasia of the colon was the presumed index source of bleeding.

In 40%-60% of patients with gastric and duodenal angiodysplasia, multiple lesions are observed at endoscopy. Colonic lesions will be associated in 15%-20% of these patients. In addition, angiodysplastic lesions in the colon are more frequently multiple than single. To diagnose and treat patients with suspected angiodysplasia, the diffuse location of lesions and the propensity for multiplicity must be considered. A possible association of true colonic diverticula and angiodysplasia has been proposed and should be kept in mind.

Hematemesis and melena are frequently observed in patients with angiodysplasia of the upper GI tract. Presentation with hemodynamically well-compensated, chronic bleeding is typical and often suggests the diagnosis. Patients with upper tract lesions may have had bleeding from days to years.

Bleeding from colonic lesions is most often chronic and low grade, but as many as 15% of patients present with acute massive hemorrhage. Patients with colonic angiodysplasia may present with hematochezia (0%-60%), melena (0%-26%), hemoccult positive stool (4%-47%), or iron deficiency anemia (0%-51%).

Melena occurs in at least one fourth of patients with colonic bleeding.

Spontaneous cessation of bleeding (occurring in 90% of patients) is the rule for angiodysplastic lesions located in any part of the GI tract.

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Physical Examination

Physical examination in a patient suspected of having angiodysplasia should include assessment of their hemodynamic stability and the likely origin of the blood loss. Note the following:

  • Extracolonic angiodysplasias occur in 17% of persons with colonic lesions. [47]

  • Vital signs may demonstrate tachycardia, hypotension, and postural changes based on the amount of blood loss.

  • Stool is typically guaiac positive. Because bleeding may be intermittent, alternating positive and negative guaiac stools can be found.

  • In most cases, bleeding presents as bright red blood, but it can also be maroon in color or melena.

  • A microcytic hypochromic anemia, reflecting iron deficiency, is observed in 10%-15% of cases.

  • Hemodynamic instability may occur if bleeding is massive. This is observed in 15% of cases.

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