Medizinische Klinik (Munich, Germany : 1983) · 2000
[Angiodysplasia of the colon as the etiology of severe, chronic recurrent intestinal hemorrhage. Idiopathic thrombocytopenia hinders early diagnosis and therapy].
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Eibner J, Stöltzing H, Thon K P
Аннотация
MEDICAL HISTORY: In 1992 a 54-year-old female patient was admitted to hospital for a severe episode of intestinal bleeding. Her medical history dated back till 1958, when an increased hemorrhagic tendency due to a thrombocytopenia was first diagnosed at the age of 20. Despite several hospital admissions and intense diagnostics, an etiological cause of the thrombocytopenia could not be found. Finally, a combination of thrombocytopenia and pathological thrombocytes had to be assumed. Because of recurrent intestinal bleedings requiring more than 250 blood transfusions and almost 100 platelet transfusions a wide spectrum of diagnostics was performed. After the cause seemed to have been found in the large bowel system during another bleeding episode, the patient was transferred to our hospital for operation.
DIAGNOSTICS: In clinical examination, except of pathological blood in her stool, nothing abnormal could be detected. The patient's hemoglobin on admission was 8.3 mg/dl. The thrombocytes ranged from 9,000 to 25,000/microliter. An ultrasound examination revealed multiple gallbladder stones. The cause of the bleeding in the right colon could finally be assured by blood scintiscanning.
THERAPY: As the bleeding was localized in the right colon, a right hemicolectomy as well as a cholecystectomy were performed. After a normal postoperative course the patient could be discharged from hospital after 12 days. Without another occurrence of an intestinal bleeding the thrombocytes ranged between 50,000 and 100,000/microliter during the following 6 years. In 1998 2 further intestinal hemorrhagic episodes with severe thrombocytopenia occurred without successful localization of the bleeding due to its spontaneous cessation.
CONCLUSION: The combination of thrombocytopenia and recurrent angioblastic bleeding of the colon has not yet been described. A more sophisticated search for the cause of the bleeding was thus hindered, as the thrombocytopenia was misinterpreted to be more the reason for than the result of the recurrent bleeding episodes.
DIAGNOSTICS: In clinical examination, except of pathological blood in her stool, nothing abnormal could be detected. The patient's hemoglobin on admission was 8.3 mg/dl. The thrombocytes ranged from 9,000 to 25,000/microliter. An ultrasound examination revealed multiple gallbladder stones. The cause of the bleeding in the right colon could finally be assured by blood scintiscanning.
THERAPY: As the bleeding was localized in the right colon, a right hemicolectomy as well as a cholecystectomy were performed. After a normal postoperative course the patient could be discharged from hospital after 12 days. Without another occurrence of an intestinal bleeding the thrombocytes ranged between 50,000 and 100,000/microliter during the following 6 years. In 1998 2 further intestinal hemorrhagic episodes with severe thrombocytopenia occurred without successful localization of the bleeding due to its spontaneous cessation.
CONCLUSION: The combination of thrombocytopenia and recurrent angioblastic bleeding of the colon has not yet been described. A more sophisticated search for the cause of the bleeding was thus hindered, as the thrombocytopenia was misinterpreted to be more the reason for than the result of the recurrent bleeding episodes.