Double-balloon endoscopy in the diagnosis and treatment of hemorrhage from retrovalvular angiodysplasias.

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.