Colonic Arteriovenous Malformations

In a 65-year-old man with a family history of colorectal carcinoma, an initial screening coloscopic examination revealed 2 arteriovenous malformations. These delicate red lesions with a vascular network and irregular edges were found in the cecum (A and B). Dr Virendra Parikh of Fort Wayne, Ind, comments that these arteriovenous malformations, which are also called angiodysplasias or vascular ectasias, are generally flat or slightly raised. They are among the most common causes of lower GI tract bleeding in elderly persons. The hemorrhages are usually selflimited or occult; however, they can be massive. Suspect this condition in elderly patients who present with iron deficiency anemia, melena, or hematochezia. Patients with asymptomatic arteriovenous malformations require observation only. Avoid surgical resection, since these lesions can be multifocal. If therapy is required, consider less invasive options, such as endoscopic treatment with cautery by laser or heater probe. No evidence of malignancy was found in this patient; thus, he required no treatment. Yearly monitoring is planned.