Angiodysplasia of the colon is a disease accompanied by the expansion and deformation of blood vessels supplying the distal part of the intestine. The main symptom of the disease is periodic bloody discharge from the rectum, which, with a prolonged course of pathology, can lead to the development of anemia. For diagnosis, a general blood test, a stool analysis for latent blood, colonoscopy, angiography of mesenteric vessels, irrigoscopy and radionuclide scintigraphy of the large intestine are used. Minimally invasive surgical methods of treatment are the most effective, conservative methods are under development.
K55.2 Colon Angiodysplasia
Angiodysplasia of the colon is a degenerative disease, which is based on persistent dilation of blood vessels with their deformation and thinning. The disease is detected mainly in elderly people over the age of 60 years. Angiodysplasia is equally common in men and women. This pathology is the cause of 4% of all cases of bleeding from the large intestine. The disease in most cases does not lead to a fatal outcome, but significantly worsens the quality of life of patients. Proctologists are engaged in the diagnosis and treatment of pathology. Specialists are developing innovative methods of treating the disease that could effectively prevent bleeding from the large intestine.
Causes of angiodysplasia
To date, the exact causes of colon angiodysplasia are not completely clear. Dysplasia can be caused by constant spasms of the large intestine, in which blood vessels dilate. Often the cause of this pathology are diseases of the gastrointestinal tract, cardiovascular diseases, kidney and lung pathology, problems with intestinal blood vessels and Willebrand’s disease. Regardless of the cause, acquired angiodysplasia is a disease in which there is a pathological structure of normally formed intestinal blood vessels. Scientists also call this condition vascular ectasia or telangiectasia.
According to the majority of specialists in the field of modern proctology, under the influence of various causes, periodic obstruction of the veins of the submucosal layer occurs, which is a consequence of smooth muscle spasm. All this over time leads to dilation of the veins and capillary network. Against this background, acquired angiodysplasia of the colon is formed. This pathological condition may be accompanied by ischemia, which aggravates the course of the disease. In some cases, angiodysplasia of the colon may be congenital. This pathology is the presence of vascular formation in the intestine – vascular malformation. The congenital variant of angiodysplasia is considered a rarer pathology.
Symptoms of angiodysplasia
The main manifestation of colon angiodysplasia is bleeding. Against this background, anemia often develops. Most bleeding is not life-threatening. Only 15% of patients have massive blood loss, which can cause a fatal outcome. Acquired colon angiodysplasia develops most often in people over 60 years of age. The main complaint of patients is bleeding from the anus. These symptoms occur against the background of physical activity or appear without a specific reason. Often patients with this pathology undergo surgical interventions for intestinal bleeding. Patients with colon angiodysplasia turn to proctologists, surgeons and gastroenterologists, but after surgery it is not possible to clearly determine the cause of bleeding.
Congenital angiodysplasia of the colon begins to manifest itself in early childhood or immediately after birth. The clinical picture in this case is also represented by intestinal bleeding. Often spotting appears after each act of defecation. An important symptom of this disease is the absolute painlessness of bleeding and their clear connection with the excretion of feces. In addition, with congenital angiodysplasia of the colon, there is a tendency to increase the volume of bleeding over time. The period of manifestation of the disease, the frequency and severity of clinical manifestations depend on the degree of damage to the large intestine.
Diagnostic measures for suspected colon angiodysplasia are prescribed during a proctologist’s consultation. Endoscopy and other instrumental techniques are used to diagnose the disease. The main method is colonoscopy with biopsy, which allows you to study the condition of the colon mucosa. With angiodysplasia of the colon, local changes may be observed, which are characteristic of hemorrhagic telangiectasia, CREST syndrome and Shereshevsky-Turner syndrome. A distinctive feature of angiodysplasia is that in this pathology there are no other clinical manifestations characteristic of these syndromes.
Colonoscopy has a high resolution, thanks to which it is possible to clearly diagnose the spread of the pathological process in the large intestine. With angiodysplasia of congenital genesis, vascular protrusions on the mucous membrane are endoscopically detected, which have the appearance of uneven elevations of various shapes. These vascular elements are usually filled with blood. The next important method of diagnosing the disease is angiography, in which the condition of the vessels of the large intestine is studied. This technique involves the introduction of an X-ray contrast agent into the venous bloodstream. Colon scintigraphy is considered a more narrowly focused diagnostic procedure. It is carried out by introducing labeled erythrocytes. The limitation of this technique is that bleeding in angiodysplasia is usually not permanent.
Contrast X-ray examination – irrigoscopy with the introduction of barium allows not only to diagnose angiodysplasia of the colon, but also to clarify its prevalence in the intestine. In addition, this technique allows you to determine the condition of the surrounding tissues, the width and functionality of the intestine. Laboratory tests are also used to diagnose this disease. It is mandatory to conduct a general blood test, in which you can detect signs of anemia due to blood loss. It is recommended to conduct a stool analysis for hidden blood, which allows you to determine the presence of blood in the stool.
Treatment of colon angiodysplasia
The main method of treating the disease is endoscopic obliterating surgery. However, their conduct does not exclude the possibility of repeated bleeding. If the patient cannot undergo surgical treatment for any reason, he is shown embolization of blood vessels through the introduction of special polymers or gel foam. Therapeutic tactics for colon angiodysplasia depends on the volume of blood loss, the frequency of bleeding and other factors. Recently, medication has been increasingly used, which eliminates bleeding due to dysplasia in the intestinal vessels. According to a number of studies, the hormonal drugs octreotide and thalidomide give good results. However, according to other experts, these funds were not effective enough.
Recently, the effect on mesenteric blood flow and the blockade of vasodilating peptides have been considered promising methods of treatment. The most common therapeutic methods of treatment are considered to be the use of estrogen and progesterone drugs. With small rarely occurring intestinal bleeding, methods of photocoagulation, endoscopic ablation and sclerosing therapy can be used. If the patient often has profuse bleeding, which dramatically worsens the clinical condition and leads to anemia, then he is shown the removal of the bleeding part of the intestine. Sigmoidectomy is most often performed, rectal resection is possible. After such interventions, reconstructive operations are performed on the sigmoid and rectum.
Prognosis and prevention
Prevention of colon angiodysplasia consists in the timely treatment of diseases of the gastrointestinal tract and other chronic pathology that can provoke the development of this disease. The prognosis for life is favorable in most cases, although proctologists do not always manage to achieve a complete cure for patients.