Ileocecal angiodysplasia in a patient with chronic renal failure: Case report and review of the Japanese literature

A 67-year-old male with chronic renal failure due to diabetic nephropathy was admitted to our hospital to start hemodialysis therapy. However the patient passed a large amount of melena without any other symptoms such as fever and abdominal pain. Bleeding lesion could not be identified by routine upper endoscopy, colonoscopy and technetium labeled erythrocyte bleeding test (red blood cell scan). Although the bleeding stopped spontaneously, it recurred later. He was treated conservatively with blood transfusion. Because of the gradual worsening of his renal function, hemodialysis was initiated. Angiography was performed before the first session of hemodialysis. A vascular tuft and draining vein followed by vascular staining were observed at the periphery of the ileocolic artery, suggesting angiodysplasia (AGD) at the ileocecum. Resection of the ileocecum was performed. A final diagnosis of ileocecal angiodysplasia was based on histopathological findings of the resected specimen. Gastrointestinal bleeding as a complication of chronic renal failure is important in the clinical setting. In particular, it is often difficult to determine the focus of intestinal bleeding. AGD must always be considered in the differential diagnosis. According to the literature from Japan, many AGD cases in Japan require angiography for final diagnosis. Surgical resection, transcatheter arterioembolization, endoscopic techniques and oral administration of hormones have been tried as therapeutic approaches. Comparative clinical study of multiple cases concerning the application of various treatment from the perspective of clinical background and long-term prognosis is needed in future.