Multiple large angiodysplasia of the right colon and aortic stenosis (Heyde-syndrome) in a patient with gastrointestinal bleeding – a case report

Introduction: Angiodysplasia of the colon is a rare abnormality, which is diagnosed in 1–3% of patients, most of them asymptomatic. Colonic angiodysplasia can be found with meticulous colonoscopic examination in about 3–6% of all patients with obscure lower gastrointestinal bleeding. Association of aortic valve stenosis and cryptogenic gastrointestinal bleeding from angiodysplasia of the cecum has been called Heyde syndrome, which is probably a rare coincidence according to recent controlled studies. In patients with significant lower gastrointestinal bleeding due to colonic angiodysplasia optimal therapy is YAG laser therapy or argon plasma coagulation, followed by surgery if re-bleeding occurred.

Case report: A 69 years old, male patient was referred from cardiology to our department for colonoscopy due to anaemia (Hgb: 64g/l) and melena. On echocardiography apart from left sided cardiac dilatation and segmental inferior wall motion abnormality, aortic valve calcification and stenosis (max. gradient 21mm Hg) were described. Previously he was on anticoagulant (cumarin) therapy due to the risk of embolisation. After cessation of anticoagulant therapy and haemodynamic stabilisation, gastroscopy and abdominal ultrasound performed without relevant abnormalities. During total colonoscopy five, separate, large angiodysplasia (1cm of diameter each) were described in the cecum, without actual bleeding. Due to high operative risk of this particular patient, he was referred to another hospital for possible endoscopic NDYAG laser therapy.

Conclusion: Colonic angiodysplasia should be considered in patients with aortic valve stenosis and obscure lower gastrointestinal bleeding. Since most of these patients are ineligible for surgery due to severe concomitant diseases, endoscopic YAG laser therapy is probably the best treatment of choice.