​Surgery - Angiodysplasia

​Surgery - Angiodysplasia 
The most prevalent location for GI mucosal vascular ectasias, or dilatation, is the colon.

Etiology 

Not precisely understood, but believed to be acquired as a degenerative process, potentially brought on by low-grade, persistent submucosal venous blockage.
The caecum and ascending colon are the usual sites of angiogenesis dysplasias, while the left colon can also be impacted.

Epidemiology 
Present in 6% of patients having a colonoscopy for a variety of reasons, and more common in older people (25 percent in those over 60, with the majority staying asymptomatic).

History 

presents with PR bleeding, which can be sudden, severe, and sporadic with a sudden cessation. Rebleeding happens frequently.

Examination 

symptoms of shock in the event of a large blood loss (tachycardia, hypotension). No distinctive symptoms were found during the abdominal exam.

Investigations 

Blood: crossmatch, FBC, U&Es, clotting, and six units if there is a substantial bleed.
Endoscopy: When the cause of a significant bleeding episode is uncertain, upper gastrointestinal endoscopy should be performed. colonoscopy when patient is stabilized and able to undergo bowel preparation.
Imaging: vascular tufts in the capillary phase and early filling of dilated veins (>1 mL/minute blood loss required to visualize bleeding source) are seen on an angiography of the superior or inferior mesenteric arteries. Radionucleotide scanning: RBCs labeled with 99mTc have a 0.5 mL/minute bleeding threshold, but they are not spatially discriminating.

Management 

Emergency care should include blood transfusion if necessary, oxygenation, IV access, resuscitation, and assessment of hemodynamic condition. Give antifibrinolytics or treat any coagulopathy. Urinary catheterization and CVP monitoring may be required in cases of severe bleeding.
Endoscopic: During a colonoscopy, diathermy or photocoagulation may be used to treat. Lesions appear as flat, elevated, or tiny cherry-red patches on a colonoscopy. In 25% of cases, there are several.
Interventional radiology: targeted embolization of bleeding arteries and angiography (may result in major side effects, such as bowel ischaemia). Better than surgery since the bleeding spot could not be seen during the procedure.
Surgery: The need is determined by the severity and pace of blood loss, as well as the accessibility of interventional radiology. An on-table colonoscopy can be done to confirm the site of the bleeding after anterograde colon lavage, which involves inserting a catheter into the appendix stump. A segmental resection, primary anastomosis, or subtotal colectomy may then be carried out.

Complications 
hemorrhage, shock from low blood volume, and problems from tests and therapy.

Prognosis 

Bleeding typically stops on its own. In the coming years, 50% of patients who had bleeding episodes and were treated conservatively with transfusion and observation will likely experience more episodes.