Angiodysplasia of the colon: A report of two cases and review of literature

Angiodysplasias of the colon are enlarged and fragile blood vessels in the colon result in occasional loss of blood from the lower gastrointestinal tract. It may be observed incidentally at colonoscopy or patients may present with lower gastrointestinal bleeding. The objective of this case report is to highlight two cases of colonic vascular ectasia seen using a Pentax video colonoscope at the Endoscopy unit of Crescent hospital, Ilorin. The first patient is an 85-year-old man, who presented with constipation, left-sided abdominal pain, and weight loss of two weeks duration. There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. Colonoscopy done, reaching the ileo-cecal valve and caecum, showed an area of dilated tortuous blood vessel (vascular ectasia) in the wall of the descending colon approximately 45 cm from the anal verge, with no features of bleeding. No ulcers or mass lesion was seen. Colonoscopy showed angiodysplasia of the colon. The second patient is a 30-year-old female trader who presented with two days history of massive hematochezia of about 7 episodes prior to presentation with an estimated blood loss per episode of about 300 ml. There were clinical features of shock. Packed cell volume at presentation was 14%. She was transfused with 4 units of fresh whole blood. Post stabilization, colonoscopy was done 5 days after bleeding had stopped, which revealed an area of erosion with mucosal blood clot about 27 cm from the anal verge. An area of angiodysplasia was seen. No hemorrhoids or mass lesion was seen anywhere in the colon. Angiodysplasia is an uncommon finding in Ilorin. These are the first reported cases of angiodysplasia of the colon from Ilorin, Nigeria.Keywords: Angiodysplasia, bleeding, colon, colonoscopyNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Diverticulosis of the colon: A report of two cases

Background: Diverticula are bulging pouch-like herniations in the wall of the hollow organ anywhere in the gastrointestinal tract from the oesophagus to the colon. Diverticula are thought to occur more commonly in the colon than in any other segment of the gastrointestinal tract. It may be asymptomatic or complicated by diverticulitis (diverticular inflammation), bleeding, or perforation with peritonitis. It could be potentially life threatening. It was thought to be rare in this part of the world, but is increasingly diagnosed with the advent of modern imaging techniques and colonoscopy. Two cases of colonic diverticula discovered during colonoscopy were highlighted.Case ReportsCase 1This patient was a 79-year old traditional ruler who presented with 2 months history of progressive left- sided abdominal pain, dull in nature and sometimes colicky but non-radiating. There was no known aggravating or relieving factors. There was associated history of chronic constipation dating back to over 15 years relieved with use of laxatives. There was no diarrhoea, vomiting or haematochezia. He had no history of previous surgeries. Physical examination showed mild tenderness at the left iliac fossa. Digital rectal examination was normal. Plain abdominal x-ray and abdomino-pelvic ultrasound scan showed no abnormalities. Colonoscopy revealed multiple diverticula with diverticulitis at the descending and sigmoid colon 40cm-60 cm from the anal verge.Case 2This patient is a 64-year old retired military officer who presented with constipation of 5 years and rectal bleeding of 10 months. Pre-morbid bowel habit was 1-2 bowel motions per day but now once in 2 days. Constipation was characterized by recurrent passage of hard pellet-like stools. This became associated with passage of fresh blood in the stool 10months ago, and anal pain. Volume of blood was about 5 mls per episode, and this occurred only when stool was hard. The anal pain was sometimes severe enough to prevent the patient from sitting comfortably on both buttocks. There was no weight loss or constipation alternating with diarrhoea. He had no history of any chronic medical illness. Colonoscopy revealed anal fissure, internal haemorrhoids, and multiple diverticula in the sigmoid and descending colon. Both patients are being managed conservatively with dietary advice and antibiotics, and still being followed up in the clinic.Conclusion: Reports of colonic diverticula with diverticulitis in this part of the world are few. This is the first report of colonic diverticulosis from Ilorin.Keywords: Colon, Diverticula, Diverticulitis, Colonscopy, Ilori

Colonoscopic examination of rectal bleeding in children: A report of two cases

Rectal bleeding in children is a frightening and cause of great concern, and of parental anxiety. In this report, we present the value of colonoscopy to unravel the diagnostic conundrum often associated with rectal bleeding in children.Key words: Children, colonoscopy, juvenile polyps, rectal bleedin

Gastric Diverticulum:A Case Report

Background: Agastric diverticulum is an out-pouching of the stomach that has similar characteristics to diverticula in other parts of the gastrointestinal tract. They are relatively rare findings.Objective: The objective of this case report is to highlight a rare case of gastric antral diverticulum discovered incidentally during upper gastrointestinal endoscopy.Case Report: A case of a 33 year old woman who presented with dyspepsia of moderate intensity, belching, nausea, but no vomiting or bloating of a fewweeks duration.An initial diagnosis of acid peptic disease was made. She had an upper gastrointestinal endoscopy done which revealed mild gastric antral and duodenal inflammation. She was placed on a triple regimen of proton pump inhibitor and two antibiotics. She had a repeatendoscopy done 8 weeks later by which time the symptoms hadgreatly improved. The second endoscopy also revealed that the inflammation had resolved however a gastric diverticulum was noted in the antrum.Conclusion: This case of gastric antral diverticulumis rare, andis the first one reported from Nigeria.Niger. Med J. Vol. 49, No. 4, Oct – Dec, 2008: 104–105.Keywords:GatricDiverticulum,Rare,Endoscop