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Anesthetic Protocol For Patients With Hereditary Hemorrhagic Telangiectasia Undergoing Enteroscopy For Angiodysplastic Lesions: A Case Report

Introduction

Anesthetic protocol for patients with hereditary hemorrhagic telangiectasia undergoing enteroscopy for angiodysplastic lesions: a case report. Anesthetic protocol for Hereditary Hemorrhagic Telangiectasia (HHT) patients undergoing enteroscopy. Manage bleeding risks, perioperative challenges, & ensure safer outcomes for this genetic disorder.

Abstract

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is a rare genetic disorder that poses significant perioperative challenges due to the risk of bleeding. We report the case of a 47-year-old male with HHT undergoing double-balloon enteroscopy (DBE) for gastrointestinal angiodysplastic lesions. Preoperative preparation included detailed screening for anemia, coagulation status, and arteriovenous malformations (AVMs). Anesthetic considerations included airway management strategies to prevent and detect telangiectasia rupture, maintenance of hemodynamic stability, and post-procedural bleeding management. Intraoperative measures included careful intubation, hemodynamic monitoring, and mitigation of embolic risks. The procedure was completed successfully, managing over 100 lesions without incident. This case highlights the importance of personalized perioperative protocols, intraoperative vigilance, and post-operative care which are crucial for the successful management of patients with HHT. We present our HHT-specific anesthetic protocol from a hematology center to address the unique challenges of HHT in endoscopic clinics, contributing to safer outcomes for patients with this rare genetic disorder.

Review

This case report, detailing an anesthetic protocol for a patient with Hereditary Hemorrhagic Telangiectasia (HHT) undergoing enteroscopy, addresses a critical gap in perioperative management for a rare and challenging genetic disorder. HHT patients present significant risks, particularly bleeding, due to widespread angiodysplastic lesions and arteriovenous malformations. The focus on a specific procedure like double-balloon enteroscopy for gastrointestinal angiodysplastic lesions further underscores the practical relevance, as such procedures carry inherent bleeding risks that are compounded in HHT. The authors' initiative to present a tailored anesthetic approach is highly commendable, offering valuable insights into managing the unique complexities of this patient population. The abstract effectively outlines the key components of the reported HHT-specific anesthetic protocol. Preoperative meticulousness, including screening for anemia, coagulation status, and AVMs, is appropriately emphasized. Crucially, the detailed intraoperative considerations, such as careful airway management to prevent telangiectasia rupture, maintenance of hemodynamic stability, and mitigation of embolic risks, highlight the comprehensive nature of their approach. The successful management of over 100 lesions without incident is a strong testament to the efficacy of their protocol. The fact that this protocol originates from a hematology center lends significant credibility, suggesting a well-integrated, multidisciplinary strategy to patient care. Overall, this case report makes a valuable contribution to the clinical literature by providing a practical framework for anesthesiologists and endoscopists managing HHT patients. It offers a clear, actionable protocol that can guide decision-making and improve patient safety in a high-risk scenario. While a single case report, it serves as an excellent starting point for establishing best practices and encouraging further research into standardized, evidence-based guidelines for HHT perioperative care. The detailed account of personalized care and intraoperative vigilance presented here will undoubtedly be beneficial for clinics encountering this rare genetic disorder.

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