Angiodysplasia in terminal ileum- how to treat?

[Sumana]

Hello, my father in law is 68-year-old. His detailed history revealed hematochezia, sometimes melena. Physical examination revealed signs of iron deficiency anemia which was confirmed by laboratory results and hemoccult positive stool. He refused the colonoscopy. Abdominal CT with contrast was then performed which revealed an evidence of abnormal subtle mural contrast flocculation within the small bowel loop with luminal extravasations of contrast at small segment of distal ileum few centimeters from ileocaecal valve with mildly dilated and early filling of its drained vein, this abnormal contrast extravasations and flocculation increased through dynamic study. In addition, evidence of contrast mural flocculation within the left lateral wall of distal few centimeters of rectum was also observed. This abnormal mural contrast flocculation within the wall of solitary segment terminal ileum and distal rectum suggest the evidence of venous ectasia or angiodysplasia. He has been diagnosed with angiodysplasia in terminal ileum. Please let me know the treatment options.

[Souptik]

@sumana This case emphasizes the critical significance of a mutual multidisciplinary approach to occult gastrointestinal bleeding. The management of angiodysplasia is considered as multidisciplinary team work that would consist of expertise from different departments as in endoscopy, angiography, and gastrointestinal surgery. In addition, council from all these departments should be present at the time of operation when surgery is recommended to optimize the time of finding the difficult lesions and wholly enhanced the chance for achievement.