Digestive Diseases and Sciences

, Volume 31, Issue 9, pp 897–905 | Cite as

Upper gastrointestinal bleeding caused by gastroduodenal vascular malformations

Incidence, diagnosis, and treatment
  • Enrique Quintero
  • Josep M. Piqué
  • Josep A. Bombi
  • Emili Ros
  • Josep M. Bordas
  • Antonio Rives
  • Josep Terés
  • Joan Rodés
Original Articles
Received:
Revised:
Accepted:

Abstract

Within a two-year period, 12 patients with upper gastrointestinal bleeding due to gastroduodenal vascular malformations were admitted to a specialized intensive care unit. They represented 2.1% of all admissions for upper gastrointestinal bleeding, and 3.7% of those with severe hemorrhage (≧2 units of blood transfused). Early endoscopy was nondiagnostic during the first bleeding episode in all nine patients with nonhereditary vascular malformations; the diagnosis was eventually made after relapsing hemorrhage by repeat endoscopy in five patients, angiography in two, and histology in another two. These nine patients accounted for 23.6% of all cases of upper gastrointestinal bleeding considered to be of unknown origin after initial work-up. The remaining three patients had Rendu-Osler-Weber disease, and the first endoscopy was diagnostic in all of them. Emergency treatment was required for 11 patients; surgery was undertaken in seven, and transendoscopic therapy (electrocoagulation or endoscopic clipping) in four. There was a 25% mortality rate. No further bleeding has occurred in eight patients after a mean follow-up period of two years. Gastroduodenal vascular malformations are a more frequent cause of upper gastrointestinal bleeding than heretofore recognized, especially in patients whose hemorrhage is deemed to be of unknown origin after an initial work-up. Endoscopy, which may need to be repeated, is the most rewarding diagnostic procedure. Awareness of their possible existence facilitates endoscopic recognition. When available, transendoscopic therapy is a good choice to stop active bleeding from such lesions.

Keywords

Public Health Mortality Rate Intensive Care Unit Good Choice Diagnostic Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Moore JD, Thompson NW, Foley D: Arteriovenous malformations of the gastrointestinal tract. Arch Surg 111:381–389, 1976Google Scholar
  2. 2.
    Gentry RW, Dockety MB, Clagett OT: Vascular malformations and vascular tumors of the gastrointestinal tract. Int Abstr Surg 88:281–323, 1949Google Scholar
  3. 3.
    Shephered JA: Angiomatous conditions of the gastrointestinal tract. Br J Surg 40:409–421, 1953Google Scholar
  4. 4.
    Fowler DL, Fortin D, Wood WG, Pinkerton JA, Konntz PG: Intestinal vascular malformations. Surgery 86:377–385, 1979Google Scholar
  5. 5.
    Farup PG, Rosseland AR, Stray N, Pytte R, Valnes K, Rand AA: Localized telangiopathy of the stomach and duodenun. Endoscopy 13:1–6, 1981Google Scholar
  6. 6.
    Sassaris M, Pang G, Hunter F: Telangiectasias of the gastrointestinal tract. Endoscopy 15:85–88, 1983Google Scholar
  7. 7.
    Rogers BHG: Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular and pulmonary disease. Gastrointest Endosc 26:134–138, 1980Google Scholar
  8. 8.
    Boley SJ, Sprayregen S, Sammartano R, Adams A, Kleinhaus S: The pathophysiologic basis for the angiographic signs of vascular ectasias of the colon. Radiology 125:615–621, 1977Google Scholar
  9. 9.
    Lewis JW, Masson EE, Jochimsen PR: Vascular malformations of the stomach and duodenun. Surg Gynecol Obstet 153:225–228, 1981Google Scholar
  10. 10.
    Reynolds DG, Swan KG: Intestinal microvascular architecture in endotoxic shock. Gastroenterology 63:601–610, 1972Google Scholar
  11. 11.
    Sheedy PF, Fulton RE, Atwell DT: Angiographic evaluation of patients with chronic gastrointestinal bleeding. Am J Radiol 123:338–347, 1975Google Scholar
  12. 12.
    Mitsudo SM, Boley SJ, Brand LJ, Montefusco CM, Sammartano RJ: Vascular ectasias of the right colon in the elderly: A distinct pathological entity. Hum Pathol 10:585–600, 1979Google Scholar
  13. 13.
    Boley SJ, Sammartano R, Adams A, Diliase A, Klinhaus S, Sprayregen S: On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology 72:650–660, 1977Google Scholar
  14. 14.
    Weaver GA, Alpern HD, Davis JS, Ramsey WH, Reichelderger H: Gastrointestinal angiodysplasia associated with aortic valve disease. Gastroenterology 77:1–11, 1979Google Scholar
  15. 15.
    Galloway SJ, Casarella WJ, Shimkin PM: Vascular malformations of the right colon as a cause of bleeding in patients with aortic stenosis. Radiology 113:11–15, 1974Google Scholar
  16. 16.
    Van Vliet ACM, Ten Kate FJW, Dees J, Van Blankestein M: Abnormal blood vessels of the prepyloric antrum in cirrhosis of the liver as a cause of chronic gastrointestinal bleeding. Endoscopy 10:89–94, 1978Google Scholar
  17. 17.
    Cunninghan JT: Gastric telangiectasias in chronic hemodialysis patients: A report of six cases. Gastroenterology 81:1131–1133, 1981Google Scholar
  18. 18.
    Ramsay DM, Buist TAS, MacLeod DAD, Heading RC: Persistent gastrointestinal bleeding due to angiodysplasia of the gut in Von Willebran's disease. Lancet 2:275–278, 1976Google Scholar
  19. 19.
    Winterbauer RH: Multiple telangiectasia, Raynaud's phenomenon, sclerodactyly and subcutaneous calcinosis: A syndrome mimicking hereditary hemorrhagic telangiectasia. Johns Hopkins Med J 114:361–383, 1964Google Scholar
  20. 20.
    Baker AL, Khan PL, Binder SC, Patterson JF: Gastrointestinal bleeding due to blue rubber bled nevus syndrome. Gastroenterology 61:530–534, 1971Google Scholar
  21. 21.
    Townw JW: Gastrointestinal bleeding associated with Turner's syndrome. J Maine Med Assoc 66:36, 1975Google Scholar
  22. 22.
    Holt JM, Wright R: Anemia due to blood loss from the telangiectases of scleroderma. Br Med J 3:537–538, 1967Google Scholar
  23. 23.
    Best EB, Teaford AK, Rader FJ Jr: Angiography in chronic recurrent gastrointestinal bleeding: a nine year study. Surg Clin North Am 59:811–829, 1979Google Scholar
  24. 24.
    Richardson JD, Max HH, Flint LM, Lewis MF, Schweisinger W, Howard M, Bradley Aust J: Bleeding vascular malformations of the intestine. Surgery 84:430–436, 1978Google Scholar
  25. 25.
    Pastershank SP, Chappel EW, Buchan DJ, Chow KC: Arteriovenous malformations of the stomach. Can Med Assoc J 110:57–58, 1974Google Scholar
  26. 26.
    Lewis TD, Laufer I, Goodacre RL: Arteriovenous malformations of the stomach. Dig Dis Sci 23:467–471, 1978Google Scholar
  27. 27.
    Baer JW, Ryan S: Analysis of cecal vasculature in the research of vascular malformations. Am J Radiol 126:394–405, 1976Google Scholar
  28. 28.
    Case records of the MGH: N Engl J Med 291:569–575, 1974Google Scholar
  29. 29.
    Hashizume M, Tanaka K, Inokuchi K: Morphology of gastric microcirculation in cirrhosis. Hepatology 3:1008–1012, 1983Google Scholar
  30. 30.
    Gannon B, Browning J, O'Brien Rogers P: Mucosal microvascular architecture of the fundus and body of human stomach. Gastroenterology 86:866–875, 1984Google Scholar
  31. 31.
    Rozental G, Bommealer G, Escourrow J: Hemorragies essentielles de la muqueuse gastrique imposant une gastrectomie totale. Nouv Press Med 11:1635–1636, 1982Google Scholar
  32. 32.
    Sellu DP, Fagan E, Allison DJ, Wood CB: Arteriovenous malformation of the stomach treated by embolization. Br J Surg 68:39–40, 1981Google Scholar
  33. 33.
    Ashawa H, Hasegaw Y: Endoscopic laser treatment for the gastric arteriovenous malformation and its fundamental analysis. Scand J Gastroenterol 17(Suppl 78):180, 1982Google Scholar

Copyright information

© Plenum Publishing Corporation 1986

Authors and Affiliations

  • Enrique Quintero
    • 1
    • 2
    • 3
  • Josep M. Piqué
    • 1
    • 2
    • 3
  • Josep A. Bombi
    • 1
    • 2
    • 3
  • Emili Ros
    • 1
    • 2
    • 3
  • Josep M. Bordas
    • 1
    • 2
    • 3
  • Antonio Rives
    • 1
    • 2
    • 3
  • Josep Terés
    • 1
    • 2
    • 3
  • Joan Rodés
    • 1
    • 2
    • 3
  1. 1.Gastroenterology Services, Endoscopy Section, Hospital Clinic i ProvincialUniversity of BarcelonaBarcelonaSpain
  2. 2.Hepatology Services, Endoscopy Section, Hospital Clinic i ProvincialUniversity of BarcelonaBarcelonaSpain
  3. 3.Histopathology Services, Endoscopy Section, Hospital Clinic i ProvincialUniversity of BarcelonaBarcelonaSpain

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