Small bowel bleeding due to angiodysplasia causing fetal death in utero

Abstract

Back ground: One of the known causes of GI bleeding is angiodysplasia, which usually causes bleeding over 70 years old patients. 30-40% of small bowel Angiodysplasia (AD) shows Gastrointestinal (GI) bleeding which occurs chronically and repeatedly. Case presentation: A 25-year-old patient in 27+6 weeks of pregnancy administered to our hospital with os bleeding. Fetal death in uterus was diagnosed with sonography and her initial lab showed hemoglobin 6.8 g/dl. On the second post operation day of cesarean section, the patient complained hematemesis and hematochezia, and her blood pressure was measured 80/50 mmHg with heart rate 128/min. Sigmoidoscopy and esophagogastroduodenoscopy were immediately done, and large amount of blood was shown at both stomach and sigmoid colon without any active bleeding site. Abdomen CT showed active small bowel bleeding with hematoma. Embolization was done and successfully blocked active bleeding. After two days, we examined capsule endoscopy and found angiodysplasia and ischemic change at jejunum. The patient was fully recovered and discharged after 8 days of delivery. Conclusions: Our report shows the rare case of young pregnant woman with angiodysplasia experiences massive GI bleeding which lead to FDIU. Our case highlights the need for close monitoring of pregnant women with bleeding diathesis such as diverticulitis and AV deformities during or before pregnancy.