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Kidney Week

Abstract: PO0480

An Unusual Cause of Anaemia: Duodenal Compression by Polycystic Kidneys

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Mehta, Maithili, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, United Kingdom
  • Duthie, Fiona, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, United Kingdom
  • O Sullivan, Eoin D., Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, United Kingdom
Introduction

We report a rare case of gastrointestinal bleeding due to extrinsic compression and shearing of bowel in a patient with autosomal dominant polycystic kidney disease (ADPKD).

Case Description

A 52-year-old male presented with progressive dyspnoea and melaena over one week. He was noted to have an eGFR of 9 ml/min/1.73 m2, giant polycystic kidneys and a family history of ADPKD. A diagnosis of ADPKD was made and he was commenced on peritoneal dialysis. He was noted to have mitral regurgitation and hypertension.

His haemoglobin at presentation was 39 g/L and his blood film revealed ovalocytes, without evidence of haemolysis. Haematinics were suggestive of iron deficiency. While uraemic at presentation, he had no other notable risk factors for bleeding. Upper GI endoscopy and colonoscopy were both unremarkable. He was treated with red cell transfusion, intravenous iron and commenced on an erythropoiesis-stimulating agent.

He presented on four subsequent occasions over an 8 month period with recurrence of severe anaemia and melaena. A capsule endoscopy suggested bleeding at the duodenal-jejunal flexure, however no source was visualised.The cause of the bleeding was revealed by double balloon enteroscopy which demonstrated extrinsic compression of the scope at D3. Review of imaging confirmed this was due to a large right renal cyst.

Ongoing tranexamic acid and lanreotide treatment has reduced the frequency of bleeds. While a nephrectomy would potentially provide a definitive solution to the underlying cause, this caries substantial risk and would need to be carefully coordinated with his mitral valve repair.

Discussion

While peptic ulcer disease is slightly increased in ADPKD, this is the first description of mechanical trauma to bowel by polycystic kidneys resulting in severe recurrent GI bleeding.

Teaching points
1. Giant polycystic kidneys can rarely compress small bowel and cause GI bleeding
2. Correlation of advanced endoscopy such as double balloon enteroscopy with radiology may be required to make the diagnosis
3. Tranexamic acid and lanreotide may reduce bleeding.

Enteroscopy (A) and CT (B) show compression point.