What is the treatment for AVM of the bowel in an 83 yr old?

AVMs are tough. Their main problem is that they cause lower GI bleeding. Although the bleeding can appear quite significant, it is usually only about 2-3 unit bleed as compared to a diverticular bleed which can be much more...but I'm swaying from the subject at hand.

AVMs bleed. There are a few ways to manage the bleeding...

1) (old fashioned way) In an 83 y.o. with an AVM it would be important to get a letter from their doctor stating that if the 83 y.o. ever has a GI bleed they should rush to a Nuclear Medicine scan - for a technetium tagged RBC study - to try to localize the specific part of the colon where the bleeding is coming from (i.e., the location of the AVM). If it can be localized then sometimes the bleeding can be stopped via angiographic means (which involves manuvering flimsy catheters through the blood vessels, to the vessel that's bleeding and put stuff in the vessel to clot it off.

If the area of bleeding can be found, and it's a relatively healthy 83 y.o. I'd recommend they undergo a removal of that part of their colon - laparoscopically if available. In younger healthy patients, removal of almost all of their colon would be ok, but in an 83 y.o. a subtotal colectomy usually results in incapacitating and debilitating diarrhea.

2). If the 83 y.o. suffers a lower GIBleed he/she will most likely be placed in an ICU and if there is a good gastroenterologist around you're in luck. After cleaning out the 83 y.o.'s colon he/she can undergo a colonoscopy with hopes of finding the source of bleeding (often better than a nuclear medicine scan or angiography) and stop the bleeding by injecting the area with epinephrine, then cauterizing the AVM. Make sure you ask if the GI doc will tattoo the area to make it easier for the surgeon to localize if necessary.

Pre-emptive endoscopic ablation -via colonoscopy - is also available but comes with it's own possible complications. Unfortunately, AVMs are often hard to find during colonoscopy as they are often affected by the drugs used for sedation. It may be worth talking to your family doc or even a GI doc about this avenue depending on the health of the 83 y.o.

Meanwhile, stick with a high fiber diet or supplement with a non-absorbent fiber such as Metamucil or Fiber-con.

Hope this helps.

If you visit this link, you will see an abstract concerning an 84 year old man who presented with Gastrointestinal angiodysplasia. The relevant treatment is discussed.
http://www.springerlink.com/content/
jv810w315g536030/
I hope this is of interest
matador 89