Recurrent Bleeding from Gastric Angiodysplasia:A Case Report

A giant gastric angiodysplasia causing recurrent gastrointestinal bleeding was found in a 51-year-old woman who had been treated with repeated blood transfusions for severe anemia. At first, no active bleeding source was seen on upper or lower GI endoscopy. The only abnormality found on gastroendoscopy was an irregular, flat, reddish mucosal lesion on the posterior wall of the antrum, which was mistaken for superficial gastritis. Subsequent endoscopic examinations were done because of intermittent gastrointestinal bleeding and revealed a 4x6 cm, irregular, mildly elevated, bright-red vascular lesion on the posterior wall of the antrum. This giant lesion had spontaneous oozing of fresh blood and was suspected to be a gastric angiodysplasia. An upper abdominal CT scan showed relative thickening of the antral wall. Because of the difficulty of treating such a large posterior antral lesion endoscopically, the patient underwent a subtotal gastrectomy. Pathologic examination revealed gastric angiodysplasia. The postoperative course was uneventful, and there was no recurrent bleeding. We present this case to remind clinicians of the importance of repeated endoscopic examinations in cases of obscure gastrointestinal bleeding, especially when active bleeding is occurring. ( J Intern Med Taiwan 2001;12:258-262 )