Angiodysplasia as a cause of Gastrointestinal Bleeding in Childhood

 

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Zusammenfassung

Während im Erwachsenenalter Angiodysplasien eine häufige Ursache gastrointestinaler Blutungen sind, ist diese Erkrankung im Kindesalter sehr selten. Wir berichten über ein 7 10/12 Jahre altes Mädchen, dass über 3 - 4 Monate an milden aber wiederkehrenden gastrointestinalen Blutungen litt. Hämatokrit, Serumferritin und Transferrinwerte lagen im Normbereich. Die Rektosigmoideoskopie zeigte eine rektale Läsion, die histologisch als Angiodysplasie charakterisiert wurde. Die Blutungen kamen spontan zum Stillstand. Während eines Nachfolgezeitraum von drei Jahren wurden keine weiteren rektalen Blutungen mehr festgestellt und die Regression der angiodysplastischen Läsion wurde endoskopisch bestätigt. Zusammenfassung: Therapeutische Strategien werden diskutiert. In Fällen einer milden klinischen Ausprägung einer kindlichen Angiodysplasie ist spontane Regression möglich und es kann eine abwartende Haltung eingenommen werden.

Abstract

Whereas in adults angiodysplasia is a frequent cause of gastrointestinal bleeding, in children this disorder is extremely rare. A 7 10/12 year old girl is presented suffering over 3 - 4 months from mild but recurrent rectal bleeding. Blood count and serum ferritin and transferrin levels were normal. The rectosigmoideoscopy revealed a rectal lesion, which was confirmed histologically as angiodysplasia. Pathological investigation of the biopsies included HE staining and immunohistological staining of endothelial cells with anti-CD34 and anti-von Willebrand factor. A follow-up period of three years revealed spontaneous regression of the angiodysplastic lesion at the rectosigmoideal localisation, which could be confirmed by endoscopy. Conclusion: The outcome of the few pediatric patients described in the literature was reviewed. Due to the lack of conclusive understanding of the nature of this extremely rare vascular disorder and the variable outcome described, a wait and see attitude should be assumed in cases of less clinical affection.

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Dr. H. Holm Uhlig

Sir William Dunn School of Pathology, University of Oxford

South Parks Road

Oxford, OX1 3RE, UK.

Phone: +44 1865 285489

Fax: +44 1865 275 591

Email: holm.uhlig@path.ox.ac.uk