Arteriovenous Malformation Detected by Small Bowel Endoscopy

Fujii, Takaaki; Morita, Hiroki; Sutoh, Toshinaga; Takada, Takahiro; Tsutsumi, Soichi; Kuwano, Hiroyuki

doi:10.1159/000367591

Cited by 17 publications

(9 citation statements)

References 5 publications

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“…In general, AVMs in the small bowel have been described as submucosal uplift accompanied by redness, vascular proliferation, and vascular ectasia. However, most of them are findings in intraoperative endoscopy, and there are a limited number of cases diagnosed by preoperative endoscopy in the absence of active bleeding [7, 8]. The present case is a valuable report of AVMs in the small bowel that could be diagnosed by preoperative DBE, and the pulsatile submucosal uplift accompanied by a small red patch on the top might be an important finding that indicates AVMs.…”

Section: Discussionmentioning

confidence: 74%

Management of Multiple Arteriovenous Malformations of the Small Bowel

Hirakawa

Ishizuka

Sato

et al. 2019

Case Reports in Medicine

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A 62-year-old Japanese female was referred to our hospital with gastrointestinal bleeding. Although small-bowel bleeding was suspected, no bleeding source was identified by enhanced computed tomography (CT), video capsule endoscopy (VCE), and double-balloon enteroscopy (DBE). Five years later, the patient had recurrent intermittent bloody stools with a significant decrease in hemoglobin levels. Although no active bleeding was observed on antegrade DBE, we detected a pulsatile submucosal uplift accompanied by a small red patch on the top of the uplift in the jejunum. Arteriovenous malformation (AVM) was suspected as the cause of small-bowel bleeding. Multiple-phase CT showed a number of small vascular ectasias during the arterial phase in the jejunum, and we confirmed the presence of multiple AVMs in the jejunum by selective angiography. To identify the location of the lesions and determine the minimal surgical margins, we performed intraoperative selective angiography with indocyanine green (ICG) injection. This technique allowed us to clearly observe the region and perform segmental small-bowel resection with minimal surgical margin. The patient reported that she has had no gastrointestinal bleeding at the two years follow-up visit.

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Section: Discussionmentioning

confidence: 74%

Management of Multiple Arteriovenous Malformations of the Small Bowel

Hirakawa

Ishizuka

Sato

et al. 2019

Case Reports in Medicine

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“…These findings are similar to the angiographic findings [ 10 ]. Furthermore, diagnosis using capsule or double-balloon endoscopy has been reported since 2000 [ 11 – 15 ]. In almost all cases that underwent endoscopy, including capsule endoscopy, small bowel endoscopy, and intraoperative endoscopy, the lesion could be identified (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Recurrent massive bleeding from a small intestinal arteriovenous malformation after surgery for biliary atresia in an infant: a case report and literature review

et al. 2021

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Background Small intestinal arteriovenous malformation (AVM) can cause bleeding. Most small intestinal AVMs occur during adulthood, rarely in infancy. We report a case of an infant with hemorrhage due to small intestinal AVM early and recurrently after Kasai portoenterostomy (PE) for biliary atresia (BA). Case presentation A 51-day-old male infant was admitted to our institution for obstructive jaundice. Laparotomic cholangiography revealed BA (IIIb1μ), and Kasai PE was performed at 60 days of age. On postoperative day 17, he developed massive melena and severe anemia. Contrast-enhanced computed tomography (CT) revealed that the jejunum around the PE site was strongly enhanced with enhancing nodules in the arterial phase, and a wide area of the Roux limb wall was slightly enhanced in the venous phase. As melena continued, emergency laparotomy was performed. There were no abnormal macroscopic findings at the PE site except for a clot in the Roux limb 5 cm away from the PE site, and the Roux limb was resected 5 cm. On further investigation, a red spot was detected on the jejunal serosa 30 cm away from the Roux-en-Y anastomosis site. PE and wedge resection for the red spot were performed. Histopathologically, both specimens indicated AVM. He was jaundice-free 65 days after the first surgery. However, at 7 months of age, he developed massive melena again. Contrast-enhanced CT and upper gastrointestinal endoscopy revealed no bleeding lesions. Hemorrhagic scintigraphy showed a slight accumulation at the hepatic hilum prompting an emergency surgery. Intraoperative endoscopy detected a bleeding lesion at the PE site, and the Roux limb was resected (approximately 6 cm). Intraoperative frozen section analysis of the stump of the resected jejunum revealed no abnormal vessels. PE was performed, and permanent section analysis revealed an AVM in the resected jejunum. The postoperative course was uneventful without re-bleeding. Conclusions We experienced a case of recurrent massive bleeding from small intestinal AVM in an infant after surgery for BA. Intraoperative endoscopy and frozen section analysis helped identify the bleeding lesion and perform a complete resection of the small intestinal AVM, even after surgery, in the infant.

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“…Table 1 shows reported cases of small intestinal AVM (18 cases) [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. Age of onset is wide-ranging (19 months to 95-years).…”

Section: Discussionmentioning

confidence: 99%