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CC BY 4.0 · Surg J (N Y) 2023; 09(04): e112-e117
DOI: 10.1055/s-0043-1776111
Case Report

Intraoperative Endoscopic-Guided Bowel Resection for Persistent Gastrointestinal Bleeding Caused by Angiodysplasia: A Case Report and Literature Review

Emily Fellows 
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
2   Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
,
Joy Harris 
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
,
Tania Kibble 
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
,
Nicholas M. McDonald 
2   Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
,
Nabeel Azeem 
2   Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
,
James V. Harmon 
1   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations Funding None.
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Abstract

Gastrointestinal angiodysplasia is an uncommon condition often associated with significant gastrointestinal bleeding that is resistant to medical therapy. We report the clinical outcomes of two patients who successfully underwent simultaneous intraoperative endoscopic and surgical interventions for the treatment of angiodysplasia. Intraoperative endoscopic guidance was found to be useful in managing hemorrhage caused by angiodysplasia in both patients. Additionally, we performed an analysis of cases reported in the literature. Our review focused on the anatomic location of the resected bowel and the clinical outcomes of patients (n = 21) with angiodysplasia managed with intraoperative endoscopy reported in the literature.

Keywords

angiodysplasia - intraoperative endoscopy - bowel resection - gastrointestinal hemorrhage

Author Contributions

E.F., J.H., T.K., and N.M. contributed to manuscript preparation. E.F. and J.H. were responsible for data collection and analysis. N.A. and J.V.H. were responsible for project conceptualization and supervision.




Publication History

Received: 12 May 2023

Accepted: 21 September 2023

Article published online:
19 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Jackson CS, Strong R. Gastrointestinal angiodysplasia: diagnosis and management. Gastrointest Endosc Clin N Am 2017; 27 (01) 51-62
    CrossrefPubMedSearch in Google Scholar
  • 2 Tartaglia D, Mazzoni A, Puglisi AG, Coccolini F, Chiarugi M. Intra-operative enteroscopy for the identification of obscure bleeding source caused by gastrointestinal angiodysplasias: through a balloon-tip trocar is better. Colorectal Dis 2020; 22 (12) 2326-2329
    CrossrefPubMedSearch in Google Scholar
  • 3 Lee J, Hwang SW, Kim J. et al. Multiple polypoid angiodysplasia with obscure overt bleeding. Clin Endosc 2016; 49 (01) 91-96
    CrossrefPubMedSearch in Google Scholar
  • 4 Martinez JC, Thomas JL, Lukaszczyk JJ. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue. Int J Surg Case Rep 2014; 5 (12) 1082-1085
    CrossrefPubMedSearch in Google Scholar
  • 5 Uhm MS, Kim N, Nah JC. et al. Congenital angiodysplasia in a woman presenting with idiopathic jejunal varicosis on angiography. Gut Liver 2009; 3 (02) 122-126
    CrossrefPubMedSearch in Google Scholar
  • 6 Douard R, Wind P, Panis Y. et al. Intraoperative enteroscopy for diagnosis and management of unexplained gastrointestinal bleeding. Am J Surg 2000; 180 (03) 181-184
    CrossrefPubMedSearch in Google Scholar
  • 7 Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A. SCARE Group. The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg 2020; 84: 226-230
    CrossrefPubMedSearch in Google Scholar
  • 8 Bollinger E, Raines D, Saitta P. Distribution of bleeding gastrointestinal angioectasias in a Western population. World J Gastroenterol 2012; 18 (43) 6235-6239
    CrossrefPubMedSearch in Google Scholar
  • 9 García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: a critical review and view points. World J Gastroenterol 2019; 25 (21) 2549-2564
    CrossrefPubMedSearch in Google Scholar
  • 10 Jackson CS, Kesavan C, Das A, Imbertson E, Strong RM. Endocuff-assisted push enteroscopy increases the detection of proximal small-bowel gastrointestinal angiodysplasias. Indian J Gastroenterol 2022; 41 (03) 300-306
    CrossrefPubMedSearch in Google Scholar
  • 11 Pinho R, Ponte A, Rodrigues A. et al. Long-term rebleeding risk following endoscopic therapy of small-bowel vascular lesions with device-assisted enteroscopy. Eur J Gastroenterol Hepatol 2016; 28 (04) 479-485
    CrossrefPubMedSearch in Google Scholar
  • 12 Gutierrez M, Kesavan C, Das A, Jackson CS, Strong RM. Strategic management of bleeding small bowel gastrointestinal angiodysplasias (GIADs): a 12 year retrospective review in a veteran population and cost comparison. Diagnostics (Basel) 2023; 13 (03) 525
    CrossrefPubMedSearch in Google Scholar
  • 13 Junquera F, Saperas E, Videla S. et al. Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia. Am J Gastroenterol 2007; 102 (02) 254-260
    CrossrefPubMedSearch in Google Scholar
  • 14 Lourdusamy D, Mupparaju VK, Sharif NF, Ibebuogu UN. Aortic stenosis and Heyde's syndrome: a comprehensive review. World J Clin Cases 2021; 9 (25) 7319-7329
    CrossrefPubMedSearch in Google Scholar
  • 15 Famularo G, Marrollo M. Of aortic valve and bleeding: Heyde's syndrome. Am J Emerg Med 2020; 38 (11) 2493.e1-2493.e2
    CrossrefPubMedSearch in Google Scholar
  • 16 Kubo T, Yoshii S, Yamano HO. et al. Jejunal angiodysplasia in an elderly patient with aortic stenosis: significance of Von Willebrand factor as an etiologic factor. Intern Med 2023; 62 (14) 2059-2062
    CrossrefPubMedSearch in Google Scholar
  • 17 Baldeosingh K, Jackson C, Olafsson S. Bevacizumab as a novel treatment for gastrointestinal angioectasias: 328. Am J Gastroenterol 2012; 107: S140-S141
    CrossrefPubMedSearch in Google Scholar
  • 18 Ge ZZ, Chen HM, Gao YJ. et al. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation. Gastroenterology 2011; 141 (05) 1629-37.e1 , 4
    CrossrefPubMedSearch in Google Scholar