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Dr. Robert D. Fusco, Medical Director    
Angiodysplasia in the Colon

Fragile Blood Vessels

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Angiodysplasia in the Colon
Angiodysplasia in the Colon
 
Above are two pictures of the lining of the right colon. These are pictures taken from a 63 year old retired school teacher who was admitted to our hospital with severe iron deficiency anemia. Her red blood cell count - hemoglobin - was about 8. (It should be about 13.) She did not see any visible blood in her stool, but a Hemoccult test demonstrated small amounts of hidden blood in every bowel movement. She had an irregular heart beat called atrial fibrillation and had been on the "blood thinner Coumadin to prevent a stroke.

The colon is much like a hollow pipe with a certain wall thickness. Within that wall there is a vast array of blood vessels. These tiny veins and arteries constantly carry oxygen and energy to the billons of cells that make up the intestinal tissues. They also serve as a tranport system to carry nutrients from the intestines to the liver and then on to the rest of the body. Usually these vessels are buried deep within the wall of the colon and not normally visible.

Fearing colon cancer as a possible cause of her slow blood loss, the patient was referred to Dr. Fusco for a colonoscopy examination. There was no colon cancer. But, here you can see a collection of small fragile arteries that have come to the surface in her right colon. This condition is called angiodysplasia. When food and waste goes through the colon, these exposed vessels can begin to bleed small amounts of blood. Usually the amount of bleeding daily is so small that it can not be seen in the stool. But, over time this will cause enough loss of blood to lead to anemia. Sometimes the bleeding is rapid and requires a trip to the hospital and a blood transfusion.

In this case, the Coumadin worsened the bleeding from the area of angiodysplasia. The area involved was too great to safely cauterize during colonoscopy. Therefore, this patient had to undergo major abdominal surgery to remove part of her colon which was diseased. The segment was removed and the two ends reattached. She did not require a colostomy "bag." She had a slow recovery but then did well. Since surgery, she has had no further problems with anemia. Colonoscopy is often used to investigate patients with signs of intestinal blood loss.

 

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