Angiodysplasia in terminal ileum: Case report and review of literature

BACKGROUND: Angiodysplasia is the second most common vascular abnormality of the GI tract after diverticulosis and is the second principal cause of lower GI bleeding over 60 years. CASE REPORT: A 68-year-old male patient presented to our institute in the outpatient clinic with pallor of gradual onset and progressive course since 6 months. Detailed history revealed hematochezia, sometimes melena. Physical examination revealed signs of iron deficiency anemia which was confirmed by laboratory results and hemoccult positive stool. The patient refused the colonoscopy. A bdominal CT with contrast was then performed which revealed an evidence of abnormal subtle mural contrast flocculation within the small bowel loop with luminal extravasations of contrast at small segment of distal ileum few centimeters from ileocaecal valve with mildly dilated and early filling of its drained vein, this abnormal contrast extravasations and flocculation increased through dynamic study. In addition, evidence of contrast mural flocculation within the left lateral wall of distal few centimeters of rectum was also observed. This abnormal mural contrast flocculation within the wall of solitary segment terminal ileum and distal rectum suggest the evidence of venous ectasia or angiodysplasia. Surgical resection was done with end to end anastomosis of the small intestine without any complication in the postoperative progress. CONCLUSION: This case also emphasizes the critical significance of a mutual multidisciplinary approach to occult gastrointestinal bleeding. The management of angiodysplasia is considered as multidisciplinary team work that would consist of expertise from different departments as in endoscopy, angiography, and gastrointestinal surgery.