Thalidomide in refractory bleeding due to gastrointestinal angiodysplasias . invalidante y recidivante por angiodisplasia intestinal: tratamiento con talidomida . ANGIODISPLASIA GASTROINTESTINAL. INTRODUCCIÓN. Las lesiones vasculares del tracto digestivo se reconocen cada vez con or frecuencia como. Get a printable copy (PDF file) of the complete article (M), or click on a page image below to browse page by page. Links to PubMed are also available for.
|Language:||English, Spanish, Arabic|
|Genre:||Science & Research|
|Distribution:||Free* [*Registration needed]|
Angiodysplasia is important in the differential diagnosis of upper gastrointestinal bleeding (UGIB), but the clinical features and outcomes associated with UGIB. A síndrome de Heyde consiste na associação de sangramento gastrointestinal por angiodisplasia e estenose valvar aórtica (EAo). Foi originalmente descrita. Angiodisplasia duodenal: relato de caso e revisão da literatura RACIONAL: Angiodisplasia duodenal é uma lesão vascular distinta da mucosa intestinal.
In hemorrhage of upper gastrointestinal tract, it is responsible for approximately 1. These lesions may occasionally cause severe bleeding.
However, the prevalence of the general population is not well known since there are many asymptomatic individuals who are not evaluated by endoscopic procedures [ 6 , 7 ]. Angiodysplastic lesions are usually small blood vessels visualized within the mucosal and submucosal layers of the gastrointestinal tract.
Histologically, the affected vessels are lined by endothelium only with little or no smooth muscle.
Endoscopically, they are flat or slightly raised, bright red in color, and well circumscribed or fernlike stellar dendrite lesions usually 2 to 10 mm in diameter. The red area appears to be composed of small blood vessels and it is surrounded by a pale area or halo. Nowadays, these lesions are increasingly detected, possibly because of the improvements in endoscopic imaging technology and increased chance of endoscopic evaluation.
On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging.
Direct serial magnification arteriography as an adjuvant in the diagnosis of surgical lesions in the alimentary tract. Am J Surg. Lower intestinal bleeding in the elderly. The aortic valve. Colonic axis. At endoscopy the lesions appear as flat or raised, smooth or irregular, red areas on normal mucosa.
The lesions can not be seen on barium studies, frequently pass unrecognized at endoscopy, and generally are undetectable at laparotomy6. Patients may be symptomless, or present with acute bleeding or iron deficiency anemia5. Endoscopy and arteriography are the mainstays of diagnosis5.
Angiographic findings, such as rapidly filling afferent arterioles, localized, berry-like vascular tufts, and the early filling of engorged veins, are highly suggestive of angiodysplasia2,5. In this case, angiography was not so effective in revealing these findings, because there were severe atherosclerotic plaque in the celiac trunk.
Precise intraoperative localization still remains a problem, because these lesions are very difficult to identify at operation as they are usually nonpalpable and nonvisible on the serosal surface3,7. The etiology for these lesions is unknown, but theories of its pathogenesis have envolved from its similarity to colonic angiodysplasia an association with renal failure4, 8,9.
The pathogenesis of the lesion seemed to be a congenital process in patients younger than 20 years of age. The number of cases increase with every year in people older than 20 years of age, suggesting a degenerative process, then angiodysplasia is presumably an acquired lesion2,4.
Supporting this point, the mean age of patients with the finding in either the upper or lower intestinal tract is greater than 60 years-old in most series4,9. Angiodysplasia has been purporsed to occur with higher frequency in patients with renal failure8,9. Lesions are usually multiple and located in the stomach and duodenum, but the jejunum and colon can also be affected.
The degree of evidence indicates that angiodysplasia is an important cause of hemorrhage in patients with chronic renal failure, but it remains to be proved if the incidence of these lesions is higher in this unique subset of patients.
It is not known from any study whether formation of angiodysplastic lesions precede or follow onset of renal dysfunction9.
The treatment of angiodysplasic lesions that are bleeding or thought to have bled is in principle straightforward, local ablation by endoscopic techniques or surgical resection5. Patients with bleeding angiodysplasia are ocasionally treated with estrogen and progesterone or, more often, by endoscopic therapy such as endoscopic injection sclerotherapy, monopolar electrocoagulation, contact probes, lasers and endoscopic ligation.
For most patients endoscopic treatment has generally replaced surgery as the first line of definitive treatment for angiodysplasias1, Conservative medical management is also reasonable for many patients with gastrointestinal bleeding due to angiodysplasia.
Despite a history of significant gastrointestinal hemorrhage, a sustained spontaneous cessation of bleeding can occur in a high percentage of patients with angiodysplasia in the upper gastrointestinal tract1. Surgery may be indicated if there are many lesions present or if endoscopic treatment is not possible5,9.
At the present case, although the patient had been successfully treated by endoscopy in the acute episodes of bleeding, it was opted to operate her, because she was persistently anemic and episodes of upper gastrointestinal bleeding were followed by circulatory shock. It would be to much dangerous to leave the lesion in the duodenum because she could suffer from a lethal hemorrhage.
The left renal artery stenosis will be managed by the vascular surgery in a second moment. Suturing angiodysplastic lesions of the small intestine. Surg Gynecol Obstet.