Læknablaðið - 15.04.1985, Side 31

LÆKNABLAÐIÐ
97
útiloka æðamisvöxt — ADCmeð æðaskoðun
hjá sjúklingum með blóðleka um endaþarm,
þar sem baríum-röntgenskoðanir og
endaþarms- og bugaristilsspeglun hafa sýnt
fram á ristilpoka, sem hugsanlegan blæðin-
garstað (4).
Vegna þess að blæðing um endaþarm getur
átt upptök í efri hluta meltingarvegar, ber að
gera sérskuggaefnisinnspýtingu bæði í iðra-
holsstofnæð (truncus coeliacus) og efri heng-
isslagæð í leit að blæðingarstað.
Ef þessar æðaskoðanir leiða ekkert í ljós, er
æskilegt að reyna að dæla skuggaefni í neðri
hengisslagæð (a. mesenterica inferior), ef
vitað er að viðkomandi hefur poka vinstra
megin í ristli og er blæðandi.
Með æðamyndatöku er unnt að staðgreina
blæðandi poka í ristli í allt að 75% tilvika, en
rannsóknin er á hinn bóginn tilgangslaus, ef
sjúklingur er ekki blæðandi. Æðamisvöxt —
ADC er hins vegar unnt að greina hvort sem er
við blæðingu eða ekki.
Meðferð kvillans var lengi vel fólgin í
brottnámi dausgarnar og botnristils (ileo —
coecal resection), en vegna endurtekinna
blæðinga hjá 12-14% sjúklinga eftir slíka
aðgerð, er nú talið æskilegt að láta brott-
námið ná til miðs þverristils (4). Dæmigerður
æðamisvöxtur — ADhefurekkiveriðgreind-
ur vinstra megin í ristli til þessa.
SUMMARY
Three patients with repeated episodes of lower gastrointe-
stinal bleeding were found by angiography and colono-
scopy to have angiodysplasia of the coecum.
After right hemicolectomy this diagnosis was confir-
med by histological examination in all cases and the
operations resulted in permanent hæmostasis.
The angiographic pattern of this apparently acquired
lesion, its histological appearance, pathophysiology and
possible etiology is discussed.
It is emphasized that the possibility of this lesion as a
source of bleeding should be considered when other
causes of lower gastrointestinal hemorrhage have been
excluded. Angiography is the method of choice to
diagnose and demonstrate the extent of angiodysplasia.
The importance of angiography of the resected specimen
is stressed.
2) Boley SJ, Sammartano R, Adams A, DiBase A,
Kleinhaus S, Sprayrenen S.: On the nature and
etiology of vascular ectasias of the colon: de-
generative lesions of aging. Gastroenterology 1977;
72: 650-60.
3) Galloway SJ, Casarella WJ and Shimkin PM.:
Vascular malformations of right colon as cause of
bleeding in patients with aortic stenosis. Radiology
1974; 113: 11-5.
4) Welch CE, Athanasoulis CA, Galdabini JJ.: He-
morrhage from the large bowel with special reference
to Angiodysplasia and diverticular disease. World J
Surg 1978; 2: 73-83.
5) Chrichlow RW, Mosenthal WT, Spiegel PK, House
RK.: Arteriovenous malformations of thebowel. An
obscurecauseofbleeding. Am J Surg 1975; 129:440-
8.
6) Baum S, Athanasoulis CA, Waltman AC.: The
angiographic diagnosis and control of large bowel
bleeding. Dis Colon Rectum 1974; 17: 446-53.
7) SmithC, Russell, Jr., Bartholomew, LloydG, M.D.,
Cain, J.C.,M.D.: Hereditary Hemorrhagic Telangi-
ectasia and gastrointestinal hemorrhage. Gastroen-
terology 1963; 44: 1-6.
8) Baer JW, Ryan S.: Analysis of coecal vasculature in
the search for vascular malformations. 1976; AJR
126: 394-405.
9) Bojsen Erik MD, Reuter SR, M.D.: Angiography in
Diagnosis of Chronic unexplained Melena. Radiolo-
gy 1967; 89: 413-19.
10) Margulis AR, Heinbacker P, Bernard HR.: Operati-
ve mesenteric arteriography in the search for the site
of unexplained gastrointestinal hemorrhage. Surge-
ry 1960; 48: 534-9.
11) Genant HK, Ranninger L.: Vascular dysplasias of
the ascending colon: Report of two cases and review
of the litterature. Am J Roentgenol Radium Ther
Nucl Med 1972; 115: 349-54.
12) Baum S, Nusbaum MH, Blakemore WS et al.: The
preoperative radiographic demonstration of intra-
abdominal bleeding from undetermined sites by
percutaneous selective celiac and superior mesenteric
arteriography. Surgery 1965; 58: 797-805.
13) Upson JF, Bunnell I, Kokkinopoulis E.: Hemangio-
ma of the coecum: diagnosis by angiography. JAMA
1971; 217: 1104-8.
14) Whitehouse GH.: Solitary angiodysplastic lesions in
the ileocoecal region diagnosed by angiography. Gut
1973; 14: 977-82.
15) Athanasoulis CA, Galdabini JJ, Waltman AC,
Novelline RA, Greenfield AJ, Ezpleta ML.: Angio-
dysplasia of the colon a cause of rectal bleeding.
Cardiovasc Radiol 1978; 1: 3-13.
16) Roberts Larry K, Bold Robert E and Routt William
E.: Gastric Angiodysplasia. Radiology 1981; 139:
355-9.
HEIMILDIR
1) Winzelberg GG et al. Evaluation of Gastrointestinal
Bleeding by Red Blood cells labelled in vivo with
Technetium-99. J Nucl Med 1979; 20: 1080-6.