Abstract
A 71-year-old man who had previously undergone laparotomy for cholecystoduodenal fistula started to complain of repeated bloody stool and progressive anemia from approximately 9 years after surgery, for which he was repeatedly admitted to and discharged from the hospital. Although he had undergone various clinical examinations, no obvious source of hemorrhage was identified. Abdominal contrast-enhanced computed tomography (CT) revealed occlusion of the superior mesenteric vein, dilation of the marginal veins of the small intestine and ascending colon, and development of collateral circulation. At a time of active hemorrhage, abdominal contrast-enhanced CT revealed pooling of the contrast agent in an area of the small intestinal wall near the navel. Preoperative markers for video-assisted thoracoscopic surgery were placed into the intestinal wall under CT guidance, and partial resection was successfully performed. The resected specimen revealed a partial defect of the small intestinal mucosa. Histopathological findings showed submucosal venous proliferation and signs of hemorrhage in the lesion, and hemorrhage from small intestinal angioectasia was diagnosed.
