Intraoperative Fluoroscopic Detection of an Occult Jejunal Arteriovenous Malformation

Abstract

A case of chronic gastrointestinal hemorrhage caused by a small jejunal arteriovenous malformation is presented. After microcatheter and microcoil placement, the patient underwent laparoscopically assisted jejunal resection. Intraoperative localization was accomplished by combined use of methylene blue injection and contrast medium injection. Methylene blue injection demarcated the segment of bowel involved and fluoroscopy by contrast medium injection revealed the arteriovenous malformation. This technique located the arteriovenous malformation during surgery and insured adequate but not excessive bowel resection.

Coil-Localized Laparoscopic-Assisted Resection of Symptomatic Gastrointestinal Vascular Malformations in Children and Young Adults

“…Some precedent for angiographic localization exists in adult patients. For example, intentional preoperative coil placement has been reported in 2 patients with jejunal AVMs ( 6 , 7 ). Coils used as a secondary localization tool at the time of laparoscopy for jejunal Dieulafoy’s lesion and jejunal AVM has also been reported in adults ( 8 , 9 ).…”

Intraoperative angiography with indocyanine green injection for precise localization and resection of small bowel bleeding

“…The marking methods used for the identification during angiography include guidewire placement, 16 Tc-labelled red blood cell injection, 17 and methylene blue dye injection through a microcatheter. [18][19][20] Guidewire localization, which surgeons accomplish using their hands, after laparotomy can be difficult, especially in patients with a fat-rich mesentery, and Tc-labelled red blood cells could be unavailable in an emergency setting. Therefore, methylene blue injection has become the preferred method.…”

Intra‐operative use of super‐selective or highly selective angiography with methylene blue injection to localize arterial‐venous malformation

“…The use of a preoperatively placed selective mesenteric angiogram catheter with injection of methylene blue dye under direct visualization of the bowel remains a valuable technique for using to isolate segments of small bowel with arteriovenous malformations [4], permitting for selective bowel resection with a low chance of recurrence and decreased morbidity. This technique can also be applied to assist laparoscopic small bowel resection [5].…”