1940 Acute Lower Gastrointestinal Bleeding Due to Multiple Colonic Polypoid Angiodysplasias in a Patient With Sickle Cell Disease

Abstract

INTRODUCTION: In patients with Sickle Cell Disease who present with hematochezia, ischemic colitis is often identified as the precipitating etiology. Angiodysplasia in sickle cell is infrequently described as the cause of hematochezia, especially in young patients. Our case illustrates the unusual finding of hematochezia due to multiple polypoid angiodysplasias distributed in the entire colon of a young patient with sickle cell disease. CASE DESCRIPTION/METHODS: A 26-year-old male with sickle cell disease leading to cirrhosis decompensated by ascites presented with multiple episodes of painless hematochezia for one day. On physical examination, he was noticed to have relative hypotension, with ascites and bright red blood on rectal exam.His initial lab work noted a hemoglobin level of 4.3 g/dL and an INR of 5.3. As he presented with hematochezia and hypotension, he underwent a computed tomography (CT) scan with intravenous contrast, which showed a blush of contrast at the splenic flexure, indicating an active luminal hemorrhage (Figure 1). However, emergent mesenteric angiography was unsuccessful in detecting active bleeding, thus, embolization could not be performed. A subsequent colonoscopy revealed 11 actively bleeding polypoid angiodysplasias distributed throughout the entire colon (Figures 2 and 3), each treated with argon plasma coagulation and clipping to prevent further bleeding. The patient did not have any recurrent episodes of bleeding throughout his hospital course, and was discharged. DISCUSSION: We present a case of acute lower gastrointestinal bleeding due to multiple colonic polypoid angiodysplasias in a young patient with sickle cell disease, successfully treated with argon plasma coagulation therapy. Colonic angiodysplasia is commonly found in individuals older than 40 years of age, generally appearing as a fern-like flat or elevated bright-red lesion on endoscopy. The polypoid form of angiodysplasia is extremely rare, reported primarily in the sigmoid and transverse colon, and is easily identified based on its striking appearance. Polypoid angiodysplasia has rarely been described in patients less than 50 years of age, and has no known association with sickle cell disease. CT angiography is a potentially crucial non-invasive initial test, as it can possibly detect extravasation from actively hemorrhaging angiodysplasias. Successful endoscopic eradication therapies include argon plasma coagulation, electrocoagulation, and snare polypectomy.