Double-Balloon Endoscopy in the Diagnosis and Treatment
of Hemorrhage from Retrovalvular Angiodysplasias
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Soeresh Jarbandhan, W.M. van der Veer, Chris J.J. Mulder
VU University Medical Center, Amsterdam, The Netherlands
Abstract
Acute rectal blood loss is a common problem that occurs most often
in the elderly. The majority of the cases are caused by diverticular
bleeding, while angiodysplasias account for about 8% of cases
with gross rectal blood loss. Angiodysplasias in the colon are
most often located in the caecum. They can cause severe colonic
bleeding, sometimes even requiring multiple transfusions. Treatment
of bleeding colonic angiodysplasias is usually done with argon
plasma coagulation (APC). We describe two cases of elderly patients
who presented with rectal blood loss, in whom gastroduodenoscopy
and colonoscopy had not revealed a bleeding focus. Both patients
were referred to our hospital for retrograde double balloon endoscopy
as it was suspected that the bleeding focus was located in the
distal small bowel. The flexible double-balloon endoscope allowed
a better and easier inspection of the caecum and the ileocaecal
valve (ICV). In both cases a large angiodysplasia was found on
the back of the ICV. After treatment with APC the bleeding stopped
and the haemoglobin levels remained within the normal range.
Keywords
Double-balloon endoscopy - colon angiodysplasia - lower gastrointestinal
bleeding.
