A case of refractory angiodysplasia of small intestine with recurrent bleeding

Abstract

A 68-year-old female received upper and lower gastrointestinal endoscopies due to severe anemia, but both studies revealed no lesions that may provoke bleeding. Then, video capsule endoscopy (VCE) was performed followed by double balloon intestinal endoscopy (DBE), and hemorrhage was found in the jejunum by the former examination, while jejunum mucosa showing redness on the surface was seen by the latter examination. DBE was done again 1month later, since progression of anemia was not discontinued, and angiodysplasia with hemorrhage was detected in the jejunum. Although clipping devise was done for the angiodysplasia under DBE, severe anemia complicated with tarry stool was not attenuated. Then, Argon Plasma Coaglation (APC) therapy through DBE was performed for hemorrhage angiodysplasia twice for 1month. However, progression of anemia with tarry stool continued despite of APC therapy and clipping devises repeatedly performed through DBE. Both APC therapy and clipping devise may be effective transiently for the arrest of bleeding from angiodysplasia on intestinal mucosa, but the therapies other than those under DBE, such as medical therapies, should be done in cases showing recurrent hemorrhage.