Adolescent with Obscure Gastrointestinal Bleeding: Angiodysplasia Requiring Arteriogram for Diagnosis

Angiodysplasia of the gastrointestinal tract is a well-known pathology causing lower GI bleeding in the adult population. Cases of angiodysplasia are rare in the pediatric literature and usually do not present with life threatening symptoms. We report a patient that presented in hemorrhagic shock due to hematochezia. She required fluid resuscitation and six units of pRBC's for stabilization. Her diagnosis was elusive and extensive diagnostic testing was negative. After discharge and subsequent recurrence of her hematochezia we considered TPA provocation which diagnosed localized angiodysplasia in the proximal ileum prior to TPA administration. This report describes our medical rationale in the diagnostic testing as well as the significant difficulties in reaching the correct diagnosis.