angiodysplasia occurring inthere has been one report of angio dysplasia and diverriculosis occurring...

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Angiodysplasia occurring in jejunal diverticulosis

EDWARD A JONES, MD, H UGI I CHAUN, BM, FRCP, FRCPC, PHILLIP SWITZER, MD, FRC PC, DAVID J CLOW, MD, RONALD J H ANCOCK, MD, FRCSC

ABSTRACT: The first case of angiodysplasia occurring in acquired jejuna! diverciculosis is reported. The patient presented with occult gastrointestinal bleeding and chronic anemia, and was created successfully by resection of a 25 cm long scpment of jejunum. Possible pathogenetic mechanisms for both angio-dysplasia and jejuna! diverticulosis are discussed. Can J Gastroenterol 1990;4(4 ): 151-153

Key Words: Anemia , Angiodysplasia, )ejunal diverticulosis , Occult gastrointestinal bleeding

Angiodysplasie et diverticulose jejunale

RESUME: On rapporte le premier cas d'angio

JONES er al

ing jejuna[ vein and a vascular tuft (Fig-ure l ), features comistent with a diag-nosis of a ngioc.l ysp las ia. Prev iou:. endoscopic examinations had revealed no angiodysplastic lesions in the large bowel, sromach or duodenum. The

patient had no evidence of aortic stcnosis orother cardiac disease. He had not taken nonsteroida l arni- inflam-matory drugs or potassium tablets which might have caused mucosa! damage and precipitated bleeding of the vascular

Figure 1) Later arterial phase of superior mesenceric arteriogram showing early i,enous filling ( left arrow) and vascular tuft (right a1,ow)

lesion. Preoperativcly, the superior mesenteric arteriogram was repeateJ and rhe catheter left in situ, with the tip lying in the fourth arcade of the jejuna[ branch artery. Ar laparotomy before the small bowel was manipulated, a bolus of methylene blue

DISCUSSION Jejuna! Jiverciculosis is not a rare

condition; prospective autopsy studies using specimen insufflation techni4ues have documented an incidence of up to 4.6% (4). Although often innocuous, they are a potential cause of malabsorp-tion, pseudo-obstruction, mechanical obstruction, volvulus, perforation, anemia, abscess formation and hemor-rhage (3,5). Bleeding from jejuna! diverticulosis was first re po rted by Braithwaite in l 923 (6). Most bleed ing from diverticula arises from no rmal blood vessels. An injury LO the mucosa due co ulceration or direct trauma from

concretions may breach vascular in-tegrity. In the present case, the hemor-rhage arose from angio

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angiodysplasia occurring inthere has been one report of angio dysplasia and diverriculosis occurring...

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