Angiodysplasie du côlon
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.
Article: Angiodysplasia.The Lancet 01/1982; 2(8259):1340. DOI:10.1016/S0140-6736(81)91355-6 · 39.21 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: 26 patients referred for colonoscopy with unexplained anaemia or blood loss per rectum were found to have angiodysplasia located in the caecum and/or ascending colon. All patients had undergone previous extensive investigation. After endoscopic photography of the lesions coagulation and biopsy were carried out in 23 patients. In 3 patients the extent of the lesion demanded surgical management, and right hemicolectomy was carried out without prior coagulation biopsy, 3 other patients underwent surgery at a later date-2 for further bleeding and 1 for complications of coagulation biopsy. Colonoscopy with photography and coagulation biopsy proved a safe and effective approach to the management of angiodysplasia in the majority of patients. It provided successful treatment and confirmation of the diagnosis without resort to major surgery, which in elderly patients is associated with high morbidity and mortality.The Lancet 08/1982; 2(8288):16-9. DOI:10.1016/S0140-6736(82)91153-9 · 39.21 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Twenty-two patients with colonic arterio-venous malformations (AVM) are reported and 218 other cases in the English literature are reviewed. Of our patients, 16 (73%) underwent right hemicolectomy because of repeated episodes of rectal bleeding or iron-deficiency anemia. Ten (63%) of these patients have remained in good health with no further evidence of intestinal bleeding after surgery. In six (37%) recurrent episodes of rectal bleeding or iron deficiency anemia have gone unexplained despite thorough work-up including repeat arteriography. Our experience and that in the literature suggests: 1. Most AVM's (78%) occur in the cecum or right colon, the jejunum being the next most common site. 2. Patients with AVM's tend to be elderly with a strong history of cardiovascular disease. A potential association between aortic stenosis, intestinal bleeding, and AVM's is suggested. However, prospective studies are needed to confirm this relationship. 3. In younger patients AVM's tend to occur at atypical sites such as the small bowel. 4. Surgical removal of an AVM cannot be expected to be uniformly curative. The causes of recurrent bleeding after surgery include: incomplete resection of the initial AVM, occult AVM's missed on arteriography and left behind at surgery, and the appearance of new AVM's postoperatively. The cause of bleeding in many patients with recurrence however, remains undiagnosed despite repeat angiography.Medicine 02/1981; 60(1):36-48. · 4.87 Impact Factor