Colon Arteriovenous Malformations
Arteriovenous malformations

Video Endoscopic Sequence 1 of 18.

Arteriovenous Malformations (AVM)

A 57-year-old female who, 10 years previously, had suffered recurrent enterorrhagia, we diagnosed an arteriovenous malformation of the cecum that was surgically treated with resection of the cecum and end-to-end anastomosis. (Colon Ilium).

It had evolved without incident until after 10 years, presents recurrent anemia Needing multiple transfusions, three previous colonoscopies were negative one practiced in Los Angeles California another in the city of Sant Ana El Salvador and the third by us. After persisting the decrease in hemoglobin, we performed another colonoscopy, finding the lesions described here. The histopathology images are correlated.

 

 

Malformación Arteriovenosa Colon

Endoscopic Sequence 2 of 18.

Case of Arteriovenous Malformations (AVM)

Arteriovenous malformations of the gastrointestinal tract are uncommon and treatment is problematic because routine barium contrast studies and endoscopy fail to demonstrate the lesion. Diagnosis is by selective mesenteric arteriography, demonstrating a characteristic vascular tuft and very early venous phase.

Arteriovenous malformations are one of the most common vascular disorders of the colon. Vascular disorders present as painless, high-volume rectal bleeding.

 

 

Malformación Arteriovenosa Colon

Video Endoscopic Sequence 3 of 18.

Colonic Arteriovenous Malformation

Arteriovenous malformations are one of the most common vascular disorders of the large intestine. They are abnormal shunts between the arteries and veins without a capillary bed and are divided into two general categories of congenital and acquired. Acquired arteriovenous malformations often occur following trauma or surgical procedures. Angiodysplasia and cavernous hemangioma are two types of arteriovenous malformations. Cavernous hemangioma is a rare congenital disorder which manifests early in life. Angiodysplasia is a degenerative lesion which can be found at any age, and its incidence increases with age. Vascular disorders presents as painless high-volume rectal bleeding. There are a few reports of vascular disorders of the intestine and rectum .

 

Malformación Arteriovenosa Colon

Video Endoscopic Sequence 4 of 18.

Several biopsies are acquired, the sensation aspect when taking the biopsy of something stony and indurated.

 

 

Malformación Arteri ovenosa Colon

Video Endoscopic Sequence 5 of 18.

Patients who have chronic lower gastrointestinal bleeding with negative conventional work-ups should undergo superior mesenteric arteriography to look for arteriovenous malformations.

 

 


 

Malformación Arteriovenosa Colon

Video Endoscopic Sequence 6 of 18.

Ulcers of the right colon due to Arteriovenous Malformations

Studies have failed to reveal a bleeding focus. In most of the cases reported, selective angiography was the only means by which a correct diagnosis could be made.

 

 

 

 

 

 

 

Malformación Arteriovenosa Colon

Video Endoscopic Sequence 7 of 18.

Ulcers of the right colon due to Arteriovenous Malformations

AVMs can be caused by tissue ischaemia secondary to circulatory failure or acquiried vascular degenerative disease associated with aging, since younger patients can develop AVMs, congenital factors are also possible, in addition to acquiered factors or aging factors.

 


Malformación Arteriovenosa Colon

Video Endoscopic Sequence 8 of 18.

Ulcers of the right colon due to Arteriovenous Malformations

The venous phase of the selective angiography visualize the origin and the extension of the AVM.

Diverse therapeutic approaches are available, including the medical, endoscopic, surgical treatment or interventional angiography, however no randomized study was able to prove the efficiency of a therapeutic method because of their low incidence.

 

 


 

Malformación Arteriovenosa Colon

Video Endoscopic Sequence 9 of 18.

Sclerotherapy is performed with infiltrations of absolute alcohol.

Endoscopic treatment by sclerotherapy or the elastic ligation has an interest at the same time diagnostic and therapeutic in the initial management of the bleeding but it is not always applicable and often has undesirable effects potentially grave, such an incomplete obliteration due to toxicity of the sclerosing product calcifying especially in big vessels; consequently an alternative approach should be used. The surgical treatment, in particular a resection of the concerned segment is rarely indicated.

Because the endoscopic and surgical therapeutic approaches have their own limits, the embolisation by angiography is considered as a relatively safe and effective method.

The haemostasis by embolization is obtained by obliteration of the principal vein in the AVM, and diverse materials of embolization are used, including reels, Gelfoam, the thrombine, the collagen, autologous blood clot and ethanol. The intestinal ischaemia is the complication dreaded with a rate of occured from 14% to 20%, however this method has a therapeutic interest, so facilitating its realization at our patient with a good short and medium-term answer.

 

Malformación Arteriovenosa Colon

Video Endoscopic Sequence 10 of 18.

Cystically dilated abnormal blood vessels at submucosa.

Colon mucosa is observed with formation of small blood vessels, tortuous and dilated that are in the submucosal and focally affecting the mucosa. One of the fragments is ulcerated and also shows tortuous vessels in the submucosa. there are also spotlights of hyperplasic colon glands. there is no evidence of malignancy.

 

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 11 of 18.

Histopathological Study

Colon mucosa is observed with formation of small blood vessels, tortuous and dilated that are in the submucosal and focally affecting the mucosa. One of the fragments is ulcerated and also shows tortuous vessels in the submucosa. there are also spotlights of hyperplasic colon glands. there is no evidence of malignancy.

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 12 of 18.

Histopathological Study of Case of Arteriovenous Malformations (AVM)

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 13 of 18.

Histopathological Study

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 14 of 18.

Histopathological Study of Case of Arteriovenous Malformations (AVM)

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 15 of 18.

Histopathological Study of Case of Arteriovenous Malformations (AVM)

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 16 of 18.

Histopathological Study of Case of Arteriovenous Malformations (AVM)

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 17 of 18.

Histopathological Study of Case of Arteriovenous Malformations (AVM)

 

 

To enlarge the image press on it

 

 

 



Malformación Arteriovenosa Colon

Video Endoscopic Sequence 18 of 18.

Histopathological Study of Case of Arteriovenous Malformations (AVM)

 

 

To enlarge the image press on it

 

 

 



2000 - 2019 gastrointestinalatlas.com
San Salvador, El Salvador | Contact