Tag: Vascular malformations

Other sources of gastrointestinal hemorrhage: The UGI tract should always be considered in patients presenting with bright red blood per rectum. Approximately 10% to 15% of cases of acute rectal bleeding have a UGI source. If an upper endoscopy and an evaluation of the colon are both negative, the small bowel should also be considered […]

Anorectal disease: Although hemorrhoids are the most common source of LGI bleeding, massive ongoing bleeding is distinctly unusual. Recurrent bleeding can occasionally lead to iron deficiency with subsequent microcytic anemia. Rarely, hemorrhoids may bleed profusely and require urgent surgical intervention. It is imperative to rule out perianal bleeding before pursuing other more complex and invasive […]

Although bloody diarrhea is common with ischemic colitis, significant LGI hemorrhage is unusual. Different types of ischemic episodes must be considered. Acute occlusive ischemic mesenteric episodes usually present as pain and, therefore, are seldom confused with other more common causes of LGI hemorrhage. Presentation is sudden and severe; the patient often has a history of […]

Focal ulceration: Focal ulceration with severe hemorrhage is a rare cause of massive LGI bleeding. This ulceration may arise from inflammatory bowel disease or after polypectomy, as discussed above, or from infection or ischemia. It’s time to pay less money – just get at the best online pharmacy. Typical infections include cytomegalovirus (in immunocompromised patients) […]

Inflammatory bowel disease: Despite that ulcerative colitis and Crohn’s disease are characterized by bleeding and diarrhea, massive hematochezia is uncommon, occurring in only 3% to 5% of all patients with massive LGI bleeding. Up to 6% of patients with Crohn’s disease or ulcerative colitis experience severe LGI bleeding. The incidence may be slightly higher in […]

Neoplasms: Occult rectal bleeding and the passage of bright red blood per rectum are typical presentations of adenomatous polyps and adenocarcinomas of the colon and rectum. Severe hematochezia, however, is relatively uncommon. Conflicting reports of incidence likely result from referral bias. Rossini et al reported that 32% of patients with massive colonic bleeding had ulcerated […]

Complication rates of endoscopic therapy of angiodys-plastic lesions range from 4% to 7%, with more complications occurring in patients who undergo heater probe treatment (7%), as opposed to bipolar electrocoagulation (4%). Cecal lesions may have a slightly increased rate of complications secondary to decreased wall thickness that makes it more susceptible to perforation. Delayed rebleeding […]

Endoscopic therapy, once reserved for high risk patients, is now considered to be standard practice for these lesions. Once the lesion has been identified, endoscopic therapy may involve heater probe, bipolar and monopolar electrode, argon plasma coagulation and laser. Several studies evaluating endoscopic electrocoagulation have found success rates ranging from 70% to 80%. The largest […]

Most (70%) colonic AVMs present with chronic, slow, intermittent and recurrent bleeding rather than hema-tochezia. Their importance in patients with massive LGI bleeding varies depending on the study reviewed. Although AVMs are responsible for only 2% of all LGI bleeding, they account for up to 30% of all episodes of massive LGI bleeding. Most of […]

Arteriovenous malformations: Arteriovenous malformations (AVMs) are also known as angiomas, angiodysplasias and vascular ectasias. They were first noted to be responsible for gastrointestinal hemorrhage in 1960, when Margulis et al, using operative mesenteric arteriography, discovered the presence of these vascular bleeding lesions. Since that time, the use of angiography and colonoscopy has identified them as […]