Massive lower gastrointestinal bleeding in a young postpartum lady: A management dilemma
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Department of Surgery, School of Medical Sciences, University Sains Malaysia, Kelantan, Malaysia
Pathology Department, School of Medical Sciences and Hospital, University Sains Malaysia, Kelantan, Malaysia
Submission date: 2020-09-27
Final revision date: 2021-03-29
Acceptance date: 2021-03-29
Online publication date: 2021-07-20
Corresponding author
Michael Pak-Kai Wong   

Department of Surgery, School of Medical Sciences and Hospital, University Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia. Tel: +60197676779.
Pol. Ann. Med. 2021;28(2):220-223
Lower gastrointestinal (GI) bleeding secondary to bleeding colonic angiodysplasia in a young population is rare. The prevalence of angiodysplasia in healthy asymptomatic adult was 0.8% and increases in elderly population, chronic renal failure, pulmonary disease, aortic stenosis, and von Willebrand disease.

We are reporting a case of a young, postpartum woman who presented to us with massive lower GI bleeding secondary to bleeding angiodysplasia. Angiodysplasia is rare in this group of patients, making the detection and treatment challenging.

Case study:
A fit 25-year-old woman presented with type IV hypovolemic shock due to massive lower GI bleeding on postpartum day 15. Emergency colonoscopy was attempted with no evidence of active bleeding detected until splenic flexure. The patient was rushed to the operation theatre for exploratory laparotomy due to unstable condition. Segmental colonic clamping was performed and due to persistent blood pooling at different segments throughout the colon, subtotal colectomy and end ileostomy were performed. Patient recovered well post-operatively.

Results and discussion:
Physiological changes during pregnancy may has aggravated the risk of bleeding in GI angiodysplasia. Following resuscitation, a lesion causing lower GI bleed can be identified and treated with a variety of endoscopic procedures, radiological and surgical interventions. In our case, the role of surgery comes in place due to massive life-threatening lower GI bleeding not responding to resuscitation.

Postpartum gastrointestinal bleeding from multiple colonic angiodysplasia is rare. It poses a challenge in diagnostic and treatment strategies. A timely individualized intervention either via endoscopy, interventional radiology or surgery is crucial and life-saving.

None declared.
None declared.
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