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Angiodysplasia of the cecum: colonoscopic diagnosis

1976; Elsevier BV; Volume: 22; Issue: 3 Linguagem: Inglês

10.1016/s0016-5107(76)73741-6

1097-6779

Richard M. Skibba, William A. Hartong, Frank A. Mantz, Daniel R. Hinthorn, James B. Rhodes,

Vascular Malformations and Hemangiomas

Arteriography was performed to determine if similar vascular malformations could be detected in the small bowel. Selective superior mesenteric injection demonstrated the cecal vascular malformation which was supplied by the cecal branch of the ileocolic artery and displayed typical early venous filling. No additional lesions were detected by superior or inferior mesenteric angiographic studies. At operation, the cecal lesion was not found even by careful inspection. Because of the preoperative documentation of a vascular malformation in the cecum, a right hemicolectomy was performed. Gross pathologic inspection was unrewarding, and attempts at arteriography in the resected specimen were unsuccessful. However, the lesion was identified after serial microscopic sectioning. Outpatient followup of the patient for 6 months revealed resolution of the anemia. Neither black nor bloody stools have been noted, and tests for occult blood in the stool have been negative. MORPHOLOGIC FINDINGS The specimen received in the laboratory consisted of a segment of cecum and ascending colon 30 cm in length with a normal appendix and a 4.5 cm segment of terminal ileum. Preliminary inspection showed no mucosal or mural abnormalities throughout. Utilizing information provided by the endoscopist and radiologist, a 3 cm broad crescentic strip of colon over a radius 7 cm from the ileocecal valve was isolated and inspected under a dissecting microscope. This disclosed a 1.2 cm area of faint hypervascularity without mucosal defect. The entire strip of colon was step-sectioned revealing, in this latter region, microscopic evidence of a fairly discrete vascular abnormality. The lesion consisted of a submucosal tangle of dilated arterial and venous, thick-walled blood vessels indicative of marked tortuosity (Figure 2). At one plane of cut, an artery and vein were found in very close juxtaposition, and the possibility of their communicating was suggested strongly. Although a small vein in one section suggested organizing thrombotic material with early angiomatoid formation, no overt embolization was discovered. Irregular and eccentric diffuse hyperplastic sclerosis of the intima of both arteries and veins was noted. Thin-walled vascular channels penetrated the muscularis mucosa terminating in acongeries ofendothelial lined, dysplastic appearing, lake-like spaces throughout the tunica propria in this area. Capillary telangiectasia was noted likewise throughout the muscularis propria and serosa. There was an area of healed erosion of the overlying mucosa. DISCUSSION Previous to the studies reported by Baum and his colleagues7,. a decade ago, reports of vascular lesions of the gastrointestinal tract were rare.g,'0 However, since that Angiodysplasia of the cecum: colonoscopic diagnosis Richard M. Skibba, MD* William A. Hartong, MD Frank A. Mantz, MD Daniel R. Hinthorn, MD James B. Rhodes, MD Department of Internal Medicine and Department of Pathology University of Kansas Medical Center Kansas City, Kansas