Unusual presentation of colonic angiodysplasia with recurrent ischemia and venous thrombosis

Colonic angiodysplasia is a common vascular malformation of the gastrointestinal tract, typically presenting with lower gastrointestinal bleeding. Ischemic complications are rare, and their association with systemic venous thrombosis has not been reported. We describe a 39-year-old man with end-stage renal disease, diabetes insipidus, and recurrent venous thromboses who presented with abdominal pain and sepsis. Computed tomography revealed colonic angiodysplasia, ischemic bowel, and a non-occlusive inferior vena cava thrombus. He underwent transverse and left hemicolectomy with stoma formation, followed by a second-look laparotomy and ileocolic anastomosis; an IVC filter was inserted. Three months later, he re-presented with peritonism and new iliac and femoral vein thrombi. Laparotomy confirmed diffuse ischemia of terminal ileum with venous engorgement but preserved arterial inflow. Histopathology demonstrated mucosal ischemia with dilated submucosal vessels. This case highlights a novel pathophysiological mechanism in which venous hypertension from systemic thrombosis exacerbates angiodysplasia, leading to recurrent ischemia despite surgical resection and filtration.