ABSTRACT
The rare cause of lower gastrointestinal bleeding is angiodysplasia. Angiolysplasia is most common in the right colon, but it can be found throughout the whole gastrointestinal tract. The main lesion of angiodysplasia is located at the submucosal layer. So, it is sometimes very difficult to search for the focus of bleeding via laparotomy or colonoscopy. We recently experienced a case of rectal arteriovenous malformation that was misdiagnosed as intussusception. A 57-year-old man visited the emergency room because of abrupt anal bleeding and low abdominal pain, and this was the third episode he'd experienced during the past 20 years. Sigmoidoscopy and abdominal CT revealed that his rectum was obstructed with a dark black colotuberant mass, which was suggestive of ischemic intussusception. We performed emergency laparotomy and we found an extremely swollen rectum with surrounding hematoma instead of intussusception. We performed low anterior resection and colo-anal anastomosis with ileostomy. The final pathologic diagnosis showed that the protuberant mass was a hematoma in the submucosal layer, and this developed by bleeding from an arteriovenous malformation in the rectum.
Subject(s)
Humans , Middle Aged , Abdominal Pain , Angiodysplasia , Arteriovenous Malformations , Colon , Colonoscopy , Emergencies , Gastrointestinal Tract , Hematoma , Hemorrhage , Ileostomy , Intussusception , Laparotomy , Rectum , SigmoidoscopyABSTRACT
Gastrojejunocolic fistula (GJCF) is mainly thought to be a late complication of inadequate gastric surgery such as insufficient gastric resection or inappropriate vagotomy. The pathogenesis of fistula formation has been accounted to the perforation of a retained jejunal marginal ulcer into the transverse colon. Most patients with GJCF present a common symptom triad of faecal vomiting, chronic diarrhea and weight loss. We recently experienced a patient with GJCF who had been suffering from diarrhea for a long period of time. He had undergone gastric surgery 8 years previously for peptic ulcer disease at another hospital. After detailed preoperative evaluation with duodenoscopy, upper gastrointestinal series, colonofiberscopy, barium enema and abdominal CT, he underwent surgery-resection of the gastric stump and segmental resection of the jejunum and transverse colon with Roux-en-Y gastrojejunostomy. Recent advances in surgical technique such as vagotomy, and medical therapy have remarkably decreased the incidence of both stomal ulcer and GJCF in peptic ulcer disease. However, gastrojejunocolic fistula should be recognized as one of the late severe complications observed after a gastrectomy with Billroth-II reconstruction, since this disease may occur even 20 years after the first operation. We report the case of a 52-year old man with gastrojejunocolic fistula with review of the literature.