Vascular ectasias of the colon

Vascular ectasias of the right colon are now recognized as a common cause of lower intestinal tract bleeding in the elderly. Ectasias were identified by angiography in 32 patients with bleeding. All but one patient was more than 55 yr of age and 22 were more than 70 yr old. Twenty-seven patients had recurrent bleeding episodes, five had single episodes and two had only chronic iron deficiency anemia. Bleeding was usually manifested by bright red blood, but mahogany colored or tarry stools were frequent. Twenty-nine patients underwent colectomy with successful immediate control of bleeding. In two others, operation was deferred because of other medical problems, and one patient died from complications of hemorrhage before a colectomy could be performed. Two patients died postoperatively of cardiac disease, one patient after a right hemicolectomy, one patient after a subtotal colectomy. Only four of the 27 patients had rebleeding after a right hemicolectomy. In each of 20 resected and injected and cleared colons, one to more than 25 mucosal ectasias were identified. The clinical and pathologic features of vascular ectasias of the colon suggest that they are degenerative lesions of aging which rarely can be identified without angiography or special pathologic techniques and which are possibly the most common cause of recurrent bleeding in the elderly. In an elderly person who has bleeding or is chronically anemic and in whom results of all studies are normal except for an angiogram showing an ectasia in the right colon, the ectasia should be considered the cause of bleeding and a right hemicolectomy should be performed.