Massive Bleeding From a Diffuse Vascular Malformation of the Small Intestine

The etiology of massive gastrointestinal tract bleeding can often be determined by obtaining a history of peptic ulcer disease, alcoholism, or a blood dyscrasia. In other instances, certain specific physical abnormalities such as an abdominal mass, palmar erythema, spider telangiectasia, or other cutaneous lesions often associated with gastrointestinal bleeding may provide a diagnosis.¹ However, a certain percentage of patients with massive gastrointestinal tract bleeding must be operated on without a definite preoperative etiologic diagnosis. A wide variety of lesions may be encountered at laparotomy, some of which may test the ingenuity to establish a diagnosis and to decide upon a proper course of therapy.²

Over the past four years, we have treated a patient with a diffuse vascular malformation of the small intestine. Episodes of massive gastrointestinal tract bleeding required multiple transfusions and seven laparotomies. No satisfactory initial preoperative diagnosis was possible, and the precise etiology of the