Intestinal vascular malformations

Introduction Vascular malformation of intestine, including arteriovenous malformation, vasodilation, hemangioma, vascular dysplasia, etc., is one of the causes of acute or chronic lower gastrointestinal bleeding, often abnormal blood vessels, but also a certain One of the manifestations of a systemic condition or a syndrome. The etiology and pathogenesis of this disease are not fully understood. It occurs in the jejunum, cecum and right colon. Children and young adults have more common vascular malformations in the jejunum. The vascular malformations in the middle and old age are more common in the colon, especially in the right colon. The main clinical manifestations of the patient were gastrointestinal bleeding and secondary anemia.

Cause

(1) Causes of the disease

The etiology and pathogenesis of this disease are not fully understood. It occurs in the jejunum, cecum and right colon. Children and young adults have more common vascular malformations in the jejunum. The vascular malformations in the middle and old age are more common in the colon, especially in the right colon. The main clinical manifestations of the patient were gastrointestinal bleeding and secondary anemia.

(two) pathogenesis

Congenital arteriovenous malformation, its pathological changes are submucosal arteriovenous traffic, venous arterialization, thickening, dilatation, distortion, and hardening of the vein wall. Occurred in the rectum and sigmoid colon, often accompanied by cardiovascular disease, peripheral vascular disease and aortic stenosis; acquired secondary to certain diseases, such as portal hypertension, intestinal submucosal wall degeneration with chronic constipation The submucosal veins that pass through the muscular layer of the intestinal wall are repeatedly compressed by muscle contraction, resulting in increased pressure in the venous lumen, dilated veins, decreased anterior capillary dysfunction, and direct communication between the arteries and veins to form functional arteriovenous fistulas. Small intestinal vascular malformations are often associated with colonic vascular malformations.

an examination

1. Selective mesenteric angiography This method is the best method for diagnosing intestinal vascular disease. It has special value for bleeding location and etiological diagnosis. The positive rate can reach 75%-90%. It is used for the location and etiology diagnosis of bleeding. It has special value and can show abnormal blood vessels during non-bleeding period. Intravenous fistula and arterial phase early manifestation: Arteriovenous fistula occurs in the early stage of the artery, showing a "double track sign", suggesting that there is traffic between the veins. Drainage veins appear early in the late arterial phase and early venous phase; local abnormally increased vascular plexus: arterial phase shows dense arrangement of peripheral blood vessels or sacral dilatation; vascular structural disorder is vine-like or chaotic; local staining is dense: appearance In the arterial phase or the parenchymal phase, and the duration is longer; the venous phase shows that the mesenteric venous dilatation, tortuosity, and contrast agent regression are slow, suggesting submucosal vein dilatation.

2, colonoscopy capsule endoscopy and enteroscopy may be able to diagnose vascular lesions of the empty and ileum, such as mucosal and submucosal veins and capillary expansion of the reticular formation, especially in young patients, vascular dysplasia usually Within 20 to 80 cm distal to the ligament of the koji. Vascular dysplasia in elderly patients occurs mostly in the right colon, but the diagnostic rate of colonoscopy is only 30% to 50%. The colonic vascular malformation is characterized by a blue-gray hemisphere or flat bulge with a diameter of 0.5 to 1.0 cm. The texture is soft and sac is sexy; some are submucosal hemorrhage or round or stellate erythema on the mucosa. Or mucosal, submucosal vasodilation increased.

3. Isotope examination For patients with negative microscopy, radionuclide imaging is performed, and isotope examination should be performed during active bleeding. When active intestinal bleeding occurs, 99Tc-labeled red blood cell ECT examination can reveal red blood cell concentration, revealing the presence of bleeding. It is generally believed that the examination does not clarify the cause and location of the bleeding and is only suitable for screening tests.

Differential diagnosis

Differential diagnosis:

1. Peptic ulcer: This disease is a chronic, recurrent disease, often manifested as rhythmic pain, with acid reflux, belching, more than autumn and winter, spring seizures, barium meal, endoscopy and angiography can be associated with vascular malformations Identification.

2. Digestive tract tumors: such as gastric cancer, small intestinal lymphoma, colorectal cancer, etc., can also be expressed as gastrointestinal bleeding, the amount of bleeding can be large or small, depending on the location, size, nature of the tumor. Also often have loss of appetite, weight loss, abdominal pain, abdominal distension and other performance. X-ray barium meal examination, endoscopic plus biopsy and angiography can confirm the diagnosis, and if necessary, laparotomy can be performed.

3. Stomach and intestinal polyps: There may be only gastrointestinal bleeding without other clinical manifestations. Endoscopic plus biopsy histopathological examination and X-ray barium meal examination can be differentiated from vascular malformations.

4. Cirrhosis of esophageal varices bleeding: If the vascular malformation is characterized by acute massive upper gastrointestinal bleeding, it should be differentiated from gastrointestinal hemorrhage caused by rupture of esophageal varices. Hepatic cirrhosis often has causes such as hepatitis, schistosomiasis, alcoholism, etc., and has coagulation mechanism, jaundice, loss of appetite and liver function damage. Laboratory tests may have abnormal liver function and coagulation mechanism. Barium meal or gastroscopy can be found in the lower esophagus and / or gastric varices can be identified with vascular malformations.

5. Acute gastric mucosal lesions: There are many incentives before the onset of the disease, such as brain trauma, drug stimulation, various stress states, etc., mostly acute onset. Emergency endoscopy can establish a diagnosis, easy to identify with vascular malformations.

6. Others: vascular malformation bleeding needs to be differentiated from ulcerative colitis, Crohn's disease, intestinal tuberculosis and other diseases. According to the clinical manifestations, laboratory tests, endoscopy, angiography, etc. of the above diseases, clear lesions can be found.

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