Small bowel vascular angiodysplasia

Case contributed by Dr Dalia Ibrahim

Presentation

Multiple episodes of melena. Iron deficiency anemia.

Patient Data

Age: 55-year-old
Gender: Male

Focal small nodular areas of enhancement and bulbous swelling of the intramural veins in the wall of the jejunum, undetectable on arterial phase and brightest on enteric phase. Enlarged draining antimesenteric jejunal veins.

Mesenteric congestion. The jejunal bowel loops show circumferential mural thickening. 

Annotated image

The first image shows focal small nodular areas of enhancement and bulbous swelling of the intramural veins in the wall of the jejunum (red circles), undetectable on arterial phase and brightest on enteric phase. Enlarged draining antimesenteric jejunal veins (yellow arrows).

The second image shows marker (Chevron) at the site of the ablated jejunal lesions using balloon-assisted endoscopy. Mesenteric smudging (congestion) is also noted.

Case Discussion

This patient had a balloon-assisted endoscopy which confirmed the jejunal angioectasia and the lesions were ablated with a marker applied to the site of intervention. Congestive enteropathy was also noted at endoscopy.

Angioectasia is the most common cause of obscure gastrointestinal bleeding.

  • they consist of thin tortuous veins that lack an internal elastic layer.
  • peak incidence: 7th and 8th decades of life

Endoscopy: angioectasias consist of punctate or patchy areas of erythema, 2–10 mm in size.

CT: focal punctate or discoid areas of enhancement <5 mm in size or bulbous swelling of the intramural vessels in the wall of the small bowel, especially in the jejunum.Enhancement is brightest during the enteric phase and fades somewhat during the delayed phase. These lesions don't enhance during the arterial phase, which distinguishes them from arterial lesions.

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Case information

rID: 50142
Case created: 20th Dec 2016
Last edited: 22nd Dec 2016
Inclusion in quiz mode: Included

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