{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:46:57Z","timestamp":1779205617591,"version":"3.51.4"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,12,23]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>A 77-year-old woman presented with obscure gastrointestinal bleeding requiring multiple hospitalisations and blood transfusions. The patient underwent repeated investigations over four hospital admissions across a span of two months. These included upper and lower gastrointestinal endoscopy, video capsule endoscopy as well as CT enterography, without definitive localisation or treatment of the source of bleeding. Finally, a technetium-99m-labelled red blood cell scan demonstrated a \u2018blush\u2019 at the proximal transverse colon on delayed imaging. Targeted colonoscopic evaluation showed a subcentimetre angiodysplastic lesion in the corresponding spot at the proximal transverse colon with slow persistent oozing. Endoscopic clips were applied with successful haemostasis. The patient recovered well without further symptom recurrence 5 months postdischarge. We review the literature on colonic angiodysplasias and discuss the diagnostic challenges in obscure gastrointestinal bleeding.<\/jats:p>","DOI":"10.1136\/bcr-2021-247595","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T11:22:28Z","timestamp":1642072948000},"page":"e247595","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Colonic angiodysplasia: a culprit of obscure gastrointestinal bleeding in a patient with Heyde syndrome"],"prefix":"10.1136","volume":"15","author":[{"given":"Ming Yoke Vera","family":"Shaw","sequence":"first","affiliation":[{"name":"General Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravishankar","family":"Asokkumar","sequence":"additional","affiliation":[{"name":"Gastroenterology, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emile John","family":"Tan Kwong Wei","sequence":"additional","affiliation":[{"name":"General Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8287-6812","authenticated-orcid":false,"given":"Isaac","family":"Seow-En","sequence":"additional","affiliation":[{"name":"General Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"2025082712431894000_15.1.e247595.1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0016-5085(00)70429-X","article-title":"American gastroenterological association medical position statement: evaluation and management of occult and obscure gastrointestinal bleeding","volume":"118","year":"2000","journal-title":"Gastroenterology"},{"key":"2025082712431894000_15.1.e247595.2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2007.06.008"},{"key":"2025082712431894000_15.1.e247595.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(99)70491-8"},{"key":"2025082712431894000_15.1.e247595.4","first-page":"243","article-title":"Early endoscopy for acute lower gastrointestinal haemorrhage","volume":"68","author":"Vellacott","year":"1986","journal-title":"Ann R Coll Surg Engl"},{"key":"2025082712431894000_15.1.e247595.5","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/00004836-198602000-00010","article-title":"Colonoscopy after Golytely preparation in acute rectal bleeding","volume":"8","author":"Caos","year":"1986","journal-title":"J Clin Gastroenterol"},{"key":"2025082712431894000_15.1.e247595.6","first-page":"564","article-title":"Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people","volume":"90","author":"Foutch","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"2025082712431894000_15.1.e247595.7","first-page":"2329","article-title":"Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia","volume":"91","author":"Chalasani","year":"1996","journal-title":"Am J Gastroenterol"},{"key":"2025082712431894000_15.1.e247595.8","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5603\/CJ.a2018.0068","article-title":"Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018","volume":"27","author":"Mohee","year":"2020","journal-title":"Cardiol J"},{"key":"2025082712431894000_15.1.e247595.9","doi-asserted-by":"crossref","DOI":"10.1056\/NEJM195807242590416","article-title":"Gastrointestinal bleeding in aortic stenosis","volume":"259","author":"Heyde","year":"1958","journal-title":"The New England Journal of Medicine"},{"key":"2025082712431894000_15.1.e247595.10","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/S0016-5085(77)80149-2","article-title":"On the nature and etiology of vascular ectasias of the colon. degenerative lesions of aging","volume":"72","author":"Boley","year":"1977","journal-title":"Gastroenterology"},{"key":"2025082712431894000_15.1.e247595.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01017.x"},{"key":"2025082712431894000_15.1.e247595.12","doi-asserted-by":"publisher","DOI":"10.1007\/BF01296266"},{"key":"2025082712431894000_15.1.e247595.13","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S1052-5157(18)30303-9","article-title":"Detection and treatment of angiodysplasia","volume":"7","author":"Krevsky","year":"1997","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"2025082712431894000_15.1.e247595.14","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2283020756"},{"key":"2025082712431894000_15.1.e247595.15","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1053\/j.tvir.2009.08.002","article-title":"Acute gastrointestinal hemorrhage","volume":"12","author":"Walker","year":"2009","journal-title":"Tech Vasc Interv Radiol"},{"key":"2025082712431894000_15.1.e247595.16","first-page":"345","article-title":"The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding","volume":"89","author":"Dusold","year":"1994","journal-title":"Am J Gastroenterol"},{"key":"2025082712431894000_15.1.e247595.17","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.19"},{"key":"2025082712431894000_15.1.e247595.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00370.x"},{"key":"2025082712431894000_15.1.e247595.19","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.3748\/wjg.v25.i21.2549","article-title":"Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: a critical review and view points","volume":"25","author":"Garc\u00eda-Compe\u00e1n","year":"2019","journal-title":"World J Gastroenterol"},{"key":"2025082712431894000_15.1.e247595.20","first-page":"CS107","article-title":"Successful endoscopic clipping for bleeding from colonic angiodysplasia in a case of Heyde syndrome","volume":"16","author":"Takahashi","year":"2010","journal-title":"Med Sci Monit"},{"key":"2025082712431894000_15.1.e247595.21","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.2169\/internalmedicine.8603-16","article-title":"Persistent gastrointestinal angiodysplasia in Heyde's syndrome after aortic valve replacement","volume":"56","author":"Akutagawa","year":"2017","journal-title":"Intern Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247595","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:43:25Z","timestamp":1756323805000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,13]]},"published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1136\/bcr-2021-247595"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247595","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}