AD is one of the most recognized causes of the gastrointestinal tract hemorrhage of obscured reason. It is formed of mucosal dilated capillaries that drain into the submucosal tortuous vein. Mostly, it is less than 5 mm and can be solitary or multiple. They are more common (about 80%) to occur in the proximal part of the colon while the small bowel and upper GIT are of less incidence [1,2,3,4].
Clinical picture is variable, and the patient can be asymptomatic, having iron deficiency anemia (due to frequent bleeding) or even can be presented by acute GIT bleeding. The lesions can be undetectable at barium study and endoscopy as well as not seen at laparotomy [3, 8].
Arteriography can play an essential role in the diagnosis of angiodysplasia with high-sensitivity and low-false-negative results (< 12%) when using selective angiography technique. It can show the feeding arteriole and the related localized, berry-like vascular tufts with early filling of efferent engorged veins [3, 10, 11].
While the etiology of duodenal angiodysplasia is still not clear, some theories were postulated to explain its pathogenesis in the view of its similarity with colonic angiodysplasia. Some considered angiodysplasia to be a congenital process in patients under 20 years old with increased its incidence as the age advances which may attributed to a degenerative process. On the other hand, some considered it as an acquired lesion, attributing their assumption to the higher prevalence in old patients (> 60 years) in most studies [3, 9].
The relation of angiodysplasia to renal failure was extensively studied. It showed a higher prevalence of these lesions in renal failure patients. Some authors assumed that it can be bleeding in up to 32% of cases associated with renal failure and rebleeding in 25–47% of cases. This can be explained by several reasons such as the platelet and use of anti-coagulants in renal patient. They recommended to consider angiodysplasia as an important reason in the differential diagnosis of GIT bleeding in chronic renal failure [1, 3, 9, 12, 13].
The minimal invasiveness and availability of CT in the emergency situations together with the technical advancement of multidetector CT (MDCT) especially its high-temporal resolution made it feasible to have high-resolution multiphasic 3D datasets in short acquisition times, thus raised the usage of CT angiography in vascular lesions especially in the scenario of active hemorrhage. This can identify the bleeding source as active extravasation of the contrast material with high sensitivity and accuracy. The accuracy of CT angiography in finding the reason of GI hemorrhage can be more than 80%. Angiodysplasia is typically appear as a vascular tuft and a large draining vein [4, 14,15,16,17,18,19,20].
The management of AD is highly dependable on the clinical situation. For incidentally discovered asymptomatic non-bleeding AD, no intervention may be required as the risk of future bleeding is low. While treatment should be considered if no other source of occult or overt GIT bleeding could be identified [1].
Superselective transcatheter embolization is currently the method of choice for managing bleeding AD especially in patients with failed endoscopic therapy or unsuitable for endoscopy and also as an alternative to surgery in high-risk patients. It shows success rate of up to 90%. It usually uses biodegradable gelatin sponges and microcoils with the possibility for re-embolization for rebleeding cases [1, 21,22,23,24,25]. The complication of that procedure can include hematomas, dissection of artery, thrombus, pseudo-aneurysm, and bowel necrosis. However, the overall complications can be about 5–9% with less than 2% to be serious ones in recent techniques [1, 23,24,25,26,27,28].
In the current case, coil embolization was done through super-selective catheterization of the feeding vessel with successful outcome and no acute complication occurred.
