ACG CASE REPORTS JOURNAL CASE REPORT | SMALL BOWEL
Solitary Polypoid Angiodysplastic Lesion Mimicking a Tumor in the Jejunum Abhishek D. Polavarapu, MBBS1, Mayurathan Kesavan, MD2, Vivek V. Gumaste, MD2, Monika Wrzolek, MD3, and Elias Purow, MD2 1
Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY 3 Department of Pathology, Staten Island University Hospital, Staten Island, NY 2
ABSTRACT Small bowel bleeding should be considered in patients with overt or occult gastrointestinal hemorrhage after normal upper and lower endoscopic examination. Angiodysplasia appearing as multiple flat vascular tufts is the most common cause of small bowel bleeding in patients over 40 years old. Polypoid angiodysplasia, however, is extremely rare. This report illustrates a unique case of solitary polypoid angiodysplasia in the jejunum of an adult with chronic kidney disease, who presented with an occult gastrointestinal bleed. The angiodysplasia mimicked tumorous growth, potentially indicative of malignant neoplasm. The patient underwent surgical resection and was histologically diagnosed as having angiodysplasia.
INTRODUCTION Approximately 5–10% of all gastrointestinal (GI) bleeding occurs from the small bowel, so the small bowel should be considered in patients presenting with overt or occult GI hemorrhage after normal upper and lower endoscopic examination.1 Angiodysplasia is the most common cause of small bowel GI bleeding, particularly in elderly patients, and is associated with various conditions, including chronic kidney disease (CKD), aortic stenosis, von Willebrand disease, and others.1 Angiodysplasia appears as multiple flat vascular tufts, and its polypoid form is extremely rare.
CASE REPORT A 76-year-old woman with end-stage renal disease presented with generalized weakness for a duration of 2 weeks. She reported having maintenance hemodialysis for 3 years. At presentation her vital signs were stable, and the exam was unremarkable. Laboratory tests revealed iron-deficiency anemia with a hemoglobin 8.1 g/dL, and a fecal occult blood test was positive. After transfusion of one unit of packed red blood cells, she underwent upper endoscopy and a colonoscopy, which failed to reveal the source of anemia. As her hemoglobin continued to decline, despite no evidence of active bleeding, she received 2 more units of packed red blood cells. Occult small bowel bleeding was suspected. Capsule endoscopy revealed a bleeding mass in the jejunum (Figure 1). A single-balloon enteroscopy revealed a friable mass 3 cm in diameter, which occupied
Solitary Polypoid Angiodysplastic Lesion Mimicking a Tumor in the Jejunum Abhishek D. Polavarapu, MBBS1, Mayurathan Kesavan, MD2, Vivek V. Gumaste, MD2, Monika Wrzolek, MD3, and Elias Purow, MD2 1
Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY 3 Department of Pathology, Staten Island University Hospital, Staten Island, NY 2
ABSTRACT Small bowel bleeding should be considered in patients with overt or occult gastrointestinal hemorrhage after normal upper and lower endoscopic examination. Angiodysplasia appearing as multiple flat vascular tufts is the most common cause of small bowel bleeding in patients over 40 years old. Polypoid angiodysplasia, however, is extremely rare. This report illustrates a unique case of solitary polypoid angiodysplasia in the jejunum of an adult with chronic kidney disease, who presented with an occult gastrointestinal bleed. The angiodysplasia mimicked tumorous growth, potentially indicative of malignant neoplasm. The patient underwent surgical resection and was histologically diagnosed as having angiodysplasia.
INTRODUCTION Approximately 5–10% of all gastrointestinal (GI) bleeding occurs from the small bowel, so the small bowel should be considered in patients presenting with overt or occult GI hemorrhage after normal upper and lower endoscopic examination.1 Angiodysplasia is the most common cause of small bowel GI bleeding, particularly in elderly patients, and is associated with various conditions, including chronic kidney disease (CKD), aortic stenosis, von Willebrand disease, and others.1 Angiodysplasia appears as multiple flat vascular tufts, and its polypoid form is extremely rare.
CASE REPORT A 76-year-old woman with end-stage renal disease presented with generalized weakness for a duration of 2 weeks. She reported having maintenance hemodialysis for 3 years. At presentation her vital signs were stable, and the exam was unremarkable. Laboratory tests revealed iron-deficiency anemia with a hemoglobin 8.1 g/dL, and a fecal occult blood test was positive. After transfusion of one unit of packed red blood cells, she underwent upper endoscopy and a colonoscopy, which failed to reveal the source of anemia. As her hemoglobin continued to decline, despite no evidence of active bleeding, she received 2 more units of packed red blood cells. Occult small bowel bleeding was suspected. Capsule endoscopy revealed a bleeding mass in the jejunum (Figure 1). A single-balloon enteroscopy revealed a friable mass 3 cm in diameter, which occupied
