Angiodysplasia of the Colon and Chronic Renal Failure

Dr. D. Rafael Matesanz, Servicio de Nefrología, Hospital Ramón y Cajal, Carretera de Colmenar, 9,100, 28034 Madrid (Spain) Dear Sir, Gastroduodenal angiodysplasia has been identified during the last years as an important cause of upper gastrointestinal bleeding in patients with chronic renal failure [1–3]. It has even been cited as the most frequent source of bleeding in these patients, in contrast to the predominance of peptic ulcer disease in the general population [4]. It was not unexpected that a pathologic process described primarily in the cecum and right hemicolon [5, 6], where more than 75% of reported cases are located [7] and which was recognized as one of the main causes of lower gastrointestinal bleeding in aged persons since the last seventies [8–10], was associated with chronic renal failure as it really happened, and several patients with angiodysplasia of the colon and chronic renal failure have been described [11–13]. We have recently observed 2 patients with this association. Case Reports A 58-year-old woman with chronic renal failure due to urolithia-sis, on maintenance hemodialysis for 2 years was hospitalized because of massive rectal bleeding which required 26 blood units (about 1 unit per day). She denied previous history of gastrointestinal disturbances. Colonoscopy (× 2), oral panendoscopy (× 2), mesenteric arteriography, gastrointestinal series and barium enema were successively performed but the source of bleeding could not be detected. After injection of πlI-oxine-labeled red blood cells, abnormal uptake was localized on the right hemicolon. At surgery there were scattered lesions up to 0,5 cm throughout the colon. A total colectomy. with ileo-rectal anastomosis was performed. The resected specimen showed multiple vascular ectasias with focal muco-sal erosions. The patient has experienced no further episodes of rectal bleeding 1 year after the operation. A 67-year-old man with chronic renal failure due to gouty nephropathy (Ccr: 13 ml/min/1.73 m2) was hospitalized for evaluation of progressive anemization (Hb decrease from 12.6 to 5,5 g/dl after 6 months) with low serum ferritin level (19 ng/ml) and guaiacpositive stools. A sigmoid diverticulosis was detected in the barium enema but the gastrointestinal series, panendoscopy (× 2), colonoscopy (×2), isotopic study with ‘“I-oxinelabeled red blood cells (× 2) and mesenteric arteriography were otherwise normal. Six months later, arteriography was repeated because of a new episode of melena (he had required 2 blood units every 2–3 weeks): anomalous vascularization was then visualized in the cecum and right hemicolon but the bleeding point could not be detected. A new isotopic study showed a pathologic uptake of the right colon, and a total colectomy with ileosigmoid anastomosis was