Managing anesthesia in a patient with hereditary hemorrhagic telangiectasia: A case report

Hereditary hemorrhagic telangiectasia (HHT) is a multisystem vascular disorder associated with fragile arteriovenous malformations (AVMs) and bleeding. We report a 72-year-old male with transfusion-dependent HHT presenting with epigastric pain and new-onset hemoptysis, found to have a left-sided hydropneumothorax and an ingested foreign body. His comorbidities included end-stage renal disease, congestive heart failure, chronic obstructive pulmonary disease, and chronic anemia. A chest tube was placed under conscious sedation, followed by total intravenous anesthesia for combined esophagogastroduodenoscopy and colonoscopy, revealing a plastic bottle cap in the distal esophagus, which was removed via gentle dilation with minimal bleeding and stable hemodynamics. This case illustrates the anesthetic complexities of HHT, highlighting the importance of preprocedural screening for AVMs, careful airway and hemodynamic management, readiness for blood product support, vigilant postprocedural monitoring for delayed bleeding, and interdisciplinary coordination.