An extreme case of Heyde syndrome.
BACKGROUND
The Heyde syndrome consists of the association of gastrointestinal bleeding from angiodysplasia with aortic valve stenosis. Its existence has been repeatedly questioned or reconfirmed, and the proposed underlying mechanism is the degradation of a coagulation factor caused by the stenotic valve, which facilitates bleeding from angiodysplastic lesions.


METHODS
We report the case of a patient with severe recurrent small-intestinal bleeding from angiodysplasia, diagnosed by a videocapsule, and aortic valve stenosis. He underwent aortic valve replacement with a bioprosthesis as an extreme life-saving procedure. The operation was followed by the cessation of bleeding for 10 months, then bleeding recurred, emergency bowel resection was needed, and was followed by a chain of events which led to the patient's death.


CONCLUSIONS
This case offers an extreme example of the challenging issues still involved in the management of patients with Heyde syndrome.
Giovannini
Ivo
I
Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of Sacred Heart School of Medicine, Rome, Italy. ivo.giovannini@rm.unicatt.it
Chiarla
Carlo
C
Murazio
Marino
M
Clemente
Gennaro
G
Giuliante
Felice
F
Nuzzo
Gennaro
G
D000368:Aged; D016888:Angiodysplasia / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D053704:Capsule Endoscopy; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012008:Recurrence; D013577:Syndrome