Abstract
A 65-year-old woman was admitted to our hospital because of repeated tarry stools. Upper and lower in-testinal examination, including panendoscopy, upper gastrointestinal series, small intestinal x-ray, barium en-ema and colonoscopy, revealed no source of bleeding. A superior mesenteric arteriogram demonstrated a di-lated draining vein from early arterial phase to late vonous phase, leading to the diagnosis of arteriovenous malformation (AVM). A microcoil was placed within the artery near the AVM lesion as a marker by the se-lective angiography technique in order to identify the lesion during surgery. The operation was started under laparoscopy. Since the laparoscopy did not enable us to find the lesion, an intraoperative fluoroscope was in-troduced. With the assistance of the laparoscopy, the lesion bearing jejunum, 33cm in length, was pulled out of the abdomen through the minilaparotomy and resected. Gross observation of the resected specimen re-vealed a circular brownish discolored area measuring 5 cm in length. Histological examination demonstratedthe dilated vessels mainly in the submucosal layer. The postoperative course was uneventful and she was dis-charged from the hospital on the 11th postoperative day. We concluded that the laparoscopic surgery com-bined with the angiographic technique of placing a microcoil is one of the effective strategies for the treat-ment of intestinal AVM.
