The rare cause of lower gastrointestinal bleeding is angiodysplasia. Angiolysplasia is most common in the right colon, but it can be found throughout the whole gastrointestinal tract. The main lesion of angiodysplasia is located at the submucosal layer. So, it is sometimes very difficult to search for the focus of bleeding via laparotomy or colonoscopy. We recently experienced a case of rectal arteriovenous malformation that was misdiagnosed as intussusception. A 57-year-old man visited the emergency room because of abrupt anal bleeding and low abdominal pain, and this was the third episode he'd experienced during the past 20 years. Sigmoidoscopy and abdominal CT revealed that his rectum was obstructed with a dark black colotuberant mass, which was suggestive of ischemic intussusception. We performed emergency laparotomy and we found an extremely swollen rectum with surrounding hematoma instead of intussusception. We performed low anterior resection and colo-anal anastomosis with ileostomy. The final pathologic diagnosis showed that the protuberant mass was a hematoma in the submucosal layer, and this developed by bleeding from an arteriovenous malformation in the rectum.
Abdominal Pain ; Angiodysplasia ; Arteriovenous Malformations ; Colon ; Colonoscopy ; Emergencies ; Gastrointestinal Tract ; Hematoma ; Hemorrhage ; Humans ; Ileostomy ; Intussusception ; Laparotomy ; Middle Aged ; Rectum ; Sigmoidoscopy

BACKGROUND: The aim of this study is to analyze the clinical significance of preoperative renal dysfunction in patients with living donor liver transplant (LDLT). METHODS: We analyzed data collected retrospectively from 327 consecutive LDLT performed at Department of Surgery, Catholic University of Korea from Jan. 2000 to Dec. 2007. Based on creatinine clearance rate (CCR) calculated before LDLT, the patients were classified in three groups: normal renal function(CCR > or =70 ml/min, 273 patients, 83.5%), mild renal dysfunction (CCR<70 ml/min and CCR > or =40 ml/min, 38 patients, 11.6%) and severe renal dysfunction (CCR<40 ml/min, 16 patients, 4.9%). The mean follow up period was 47.5 months. RESULTS: The patient with severe renal dysfunction had higher incidence of postoperative dialysis and longer hospital stay (P<0.001). During the 3 months follow up period, the mean serum creatinine level in patients with severe renal dysfunction were not normalized and the incidence of renal dysfunction (serum creatinine, >1.5 mg/dl) was up to 46.2%. Even in patient with normal renal function, the incidence of postoperative hemodialysis and renal dysfunction 3 months postoperatively was about 5%. Multivariate analysis showed that preoperative serum creatinine, MELD score and postoperative diabetes predicted postoperative renal dysfunction. There was no statistical difference in survival curve between normal and mild renal dysfunction group but the patient with severe renal dysfunction showed worse survival compare with other groups (P < 0.001). CONCLUSIONS: Our data suggested that the patient with preoperative severe renal dysfunction have had poor recovery of renal dysfunction and high incidence of hemodialysis postoperatively and showed worse survival rate after transplantation.
Adult ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Length of Stay ; Liver ; Living Donors ; Multivariate Analysis ; Renal Dialysis ; Retrospective Studies ; Survival Rate ; Transplants