A case of small bowel arteriovenous malformation in which the lesion was identified intraoperatively by placing an intravascular microcoil

Abstract

A 58-year-old man was admitted to the hospital for close exploration of anal bleeding in July 2008. On the second hospital day he developed cardiopulmonary arrest temporarily due to massive anal bleeding. After resuscitation, a contrast-enhanced abdominal CT scan showed extravasation of contrast material into the jejunum, and bleeding from the jejunum was diagnosed. Emergency angiography was thus performed. Bleeding from the periphery of the 3^rd jejunal artery was identified and arterial embolization was carried out. On the 3^rd hospital day, we decided to perform emergency partial resection of the small intestine including the bleeding lesion. It was supposed that we might have to have difficulty in identifying the lesion during surgery, so that angiography was performed again immediately before surgery. Marking with a microcoil was conducted at the periphery of the jejunal artery from where the bleeding was seen on the day before, and then laparotomy was done. Intraoperative fluoroscopic study identified the coil was present at the small bowel mesentery, about 60 cm apart from the Treitz' ligament. The small intestine by 60 cm in length including the lesion was resected. A 1.4×1.0 cm elevated lesion was seen on the mucosa at the center of the resected material. The histopathological diagnosis was arteriovenous malformation of the small intestine. Multiple organ failure was developed after the operation, but, following intensive care, the patient was discharged from the hospital on the 44^th postoperative day without any sequela.