Angiodysplasie du côlon

Acta Endoscopica (Impact Factor: 0.16). 14(2):93-99. DOI: 10.1007/BF02966100

ABSTRACT L’angiodysplasie du côlon est une cause très fréquente d’hémorragie digestive basse.

Entre février 1974 et mai 1983, l’angiodysplasie du côlon a été diagnostiquée chez 17 malades, dont 11 depuis 1980. Nous avons
examiné 8 hommes et 9 femmes dont l’âge se situait entre 51 et 87 ans (moyenne : 68,6 ans) ; trois patients seulement n’avaient
pas atteint l’âge de 60 ans.

Ils étaient hospitalisés ð cause d’une hémorragie digestive chronique et intermittente, une hémorragie aiguë et massive (12
%) ou pour une anémie ferriprive (18 %). Le saignement rectal peut s’exprimer par l’émission de sang rouge (47 %) ou non (59
%). Une angiographie pratiquée chez 15 patients a démontré l’angiodysplasie chez 13 (87 %) ; les 2 patients avec angiographie
négative ont subi une coloscopie avec des biopsies positives. Deux patients n’ont pas subi d’angiographie : le premier a été
opéré en urgence ð cause d’une hémorragie cataclysmique, chez l’autre le diagnostic a été posé par la coloscopie. La majorité
des angiodysplasies était localisée au côlon droit (14/17). Le traitement de choix a été une hémicolectomie droite ; une résection
du sigmoïde a été exécutée chez 2 patients ; trois patients ont subi une coagulation endoscopique.

Angiodysplasia of the colon is a common cause of lower intestinal tract bleeding. Between February 1974 and May 1983 angiodysplasia
was diagnosed in 17 patients, 11 of them since 1980. The sex ratio was 8 men and 9 women with an age distribution of 51 to
87 years (mean 68,6 years), only 3 of them being younger than 60 years. They presented with a history of chronic intermittent
gastrointestinal bleeding, massive bleeding (12 %) or chronic iron deficiency anemia (18 %). The bleeding could be bright
red (47 %) as well as melena (59 %). An arteriography was performed in 15 patients and demonstrated angiodysplasia in 13 (87
%) ; the 2 patients with a negative arteriography had a colonoscopy with positive biopsies. Two patients underwent no angiography
: the first needed an urgent operation because of massive bleeding and in the other the diagnosis was made by colonoscopy.
Most angiodysplastic lesions were located in the right colon (14/17). The treatment of choice was a right hemicolectomy; a
resection of the sigmoid was performed in 2 patients and endoscopic coagulation in 3 patients.

  • The Lancet 01/1982; 2(8259):1340. · 39.21 Impact Factor
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    ABSTRACT: Vascular ectasias (angiodysplasias, arteriovenous malformations) of the cecum and ascending colon are a frequent cause of lower intestinal bleeding in the elderly that has been overlooked by clinicians and pathologists. Their nature and etiology have been poorly understood until recently. This article reviews the previous literature and presents a complete and detailed description of these lesions based on the examination of 87 areas showing vascular ectasia from 26 colons. Their morphology spans a spectrum from small focal early lesions to multiple large late lesions. The early lesions are characterized by markedly dilated, large, tortuous submucosal veins with minimal dilatation of their tributaries in the mucosa. The late lesions showed further dilatation of submucosal veins and venules and extensive replacement of the overlying mucosa by racemose collections of dilated and thin walled venules and capillaries, three of which demonstrated rupture into the colonic lumen. The pathology of these lesions is considered to be specific enough to establish vascular ectasias of the colon as a distinct entity.
    Human Pathlogy 10/1979; 10(5):585-600. · 2.84 Impact Factor
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    ABSTRACT: A series of 72 patients with bleeding either from angiodysplasia or diverticular disease of the colon has been studied in the Massachusetts General Hospital. Modern angiographic techniques have dispelled much of the mystery and reduced the mortality of colonic bleeding. In this series 85% of the bleeding originated from the right or transverse colon. Of the 72 patients, 70 survived; there were 52 operations. The 2 deaths occurred in an 81-year-old patient after subtotal colectomy and an 84-year-old patient after right colectomy, both for diverticular bleeding. After discharge from the hospital, 67 patients have been followed up for a median interval of 22 postoperative months. Late follow-up of patients with bleeding from either angiodysplasia or diverticula showed that segmental resection was successful in stopping bleeding in 38 of 42 patients (90%); the 10 patients who had subtotal colectomy had no recurrent bleeding. The choice of operation must depend upon many factors that reflect operative risks, which must be balanced against better control of bleeding by subtotal colectomy. Because a right colectomy for angiodysplasia has been followed by recurrent bleeding in 4 of 31 cases, it is suggested that the right half of the transverse colon be included in the right colectomy since this will introduce no greater hazard and may lead to better control of bleeding. Subtotal colectomy is the operation of choice for bleeding from the colon from an unknown source, in good-risk patients with widespread diverticulosis involving all segments of the colon, and for a combination of angiodysplasia on the right and extensive diverticular disease on the left. In poor-risk patients, if either angiodysplasia or a single bleeding point has been demonstrated by selective arteriography, a segmentai resection of that area will be the safest procedure.Nous avons soign, au Massachusetts General Hospital, 72 malades prsentant une hmorragie digestive par angiodysplasie ou diverticulose colique. Les techniques modernes d'angiographie ont clarifi le problme des hmorragies coliques et rduit la mortalit. Dans notre srie, 85% des hmorragies venaient du colon droit ou transverse. Sur les 72 malades, il y a 70 survivants; 52 ont t oprs. Les dcs sont survenus, aprs colectomie sub-totale chez un patient de 81 ans et aprs colectomie droite chez un malade de 84 ans, tous deux prsentant des hmorragies d'origine diverticulaire. Le follow-up porte sur 67 malades suivis, en moyenne, pendant 22 mois: une colectomie segmentaire a arrt toute hmorragie chez 38/42 patients (90%) atteints d'angiodysplasie ou de diverticulose; aprs colectomie sub-totale, il n'y a eu aucune rcidive d'hmorragie (10 cas).Le choix de l'une ou l'autre opration dpend de divers lments, dont le risque opratoire et le meilleur contrle de l'hmorragie par la colectomie sub-totale. La colectomie droite pour angiodysplasie a donn 4 rcidives sur 31 cas; nous estimons donc qu'il faut l'tendre la moiti droite du transverse. Lorsque la cause de l'hmorragie colique est inconnue, la colectomie sub-totale est la meilleure opration pour les malades faible risque qui ont une diverticulose tendue tout le colon ou une angiodysplasie du colon droit avec diverticulose tendue du colon gauche. Chez les malades haut risque chez qui l'angiographie a montr, soit une angiodysplasie, soit une seule source d'hmorragie, il faut faire une colectomie segmentaire.
    World Journal of Surgery 02/1978; 2(1):73-83. · 2.23 Impact Factor