A case report of duodenal arteriovenous malformation: usefulness of intraoperative indocyanine green angiography for precise identification of the lesion

Abstract

Background Arteriovenous malformation (AVM) of the gastrointestinal (GI) tract can cause bleeding. The treatment choice for GI tract AVM is surgical resection of the involved bowel segment with complete resection of the nidus. The AVM formed in the duodenum or pancreatic head could also cause gastrointestinal bleeding, and there are several reports of pancreaticoduodenectomy as its treatment. However, if the area of AVM can be accurately identified during surgery, it may be possible to completely resect the AVM while preserving the organ. We report a case of duodenal AVM in a patient successfully treated with a subtotal stomach-preserving duodenal bulb resection using intraoperative indocyanine green (ICG) angiography technique. Case presentation An 18-year-old man was diagnosed with duodenal AVM after several examinations for anemia and was referred to our hospital for further treatment. Preoperative imaging studies showed that the inflow vessels of this duodenal AVM were the inferior pyloric artery and the superior duodenal artery, and the AVM was localized to the duodenal bulb. Thereafter, stomach-preserving duodenal bulb resection preceded by ligation of the inflow vessels was performed. During the surgery, ICG angiography clearly demonstrated the area, where the nidus was distributed, and a duodenal bulb resection with complete resection of the AVM was successfully performed. There was no recurrence at the 6-month follow-up. Conclusions Intraoperative ICG angiography was a useful procedure for precise identification of the AVM of the GI tract.

Arteriovenous malformation of the small intestine presenting with a transfusion-dependent anaemia in pregnancy

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Case report: video-assisted thoracoscopic surgery for pulmonary arteriovenous malformation using near-infrared fluorescence with indocyanine green

“…Near-infrared fluorescence (NIF) imaging with indocyanine green (ICG) has recently emerged as a promising method to localize pulmonary nodules. A growing series of publications demonstrated the efficacy of ICG in vascular tissue identification [ 6 – 9 ]. Considering its wide usage in angiography, it might help guide the detection of pulmonary vascular malformations.…”

An Update of Treatment of Pancreatic Arteriovenous Malformations

“…In the visceral arteriovenous malformations (AVM), there are many kinds of AVMs, including renal [1], pancreatic [2], hepatic [3], intestinal [4], gallbladder [5], and duodenum [6]. Pancreatic AVM is relatively rare, with about 200 case reports or series available.…”