A Laparoscopically Resected Case of Arteriovenous Malformation of the Lesser Omentum Causing Recurrent Hemorrhage

Abstract

A 30-year-old woman presented with acute abdominal pain and was diagnosed as having an atraumatic intraabdominal hematoma. No further evaluation and intervention were performed because the hematoma on the lesser omentum had shrunk one month later. Her outpatient follow-up was maintained ; however, the hematoma recurred five months later. Contrast-enhanced abdominal CT images revealed a 3-cm tumor-like lesion with a high density area on the side of lesser curvature, although no extravasation of contrast medium was observed. Abdominal angiogram showed no evidence of vascular disease, whereas the right gastric artery was not visualized. We diagnosed the case as recurrent hemorrhage of vascular or neoplastic disease of the lesser omentum, and decided to parform laparoscopic surgery. Intraoperative findings revealed a hen's egg- sized mass lesion at the tip of vascular pedicle from the lesser omentum, and the lesion was laparoscopically resected. Pathological examination revealed arteriovenous malformation (AVM) of the lesser omentum with hemorrhage. Intraabdominal AVM is a rare cause of atraumatic intraabdominal hemorrhage ; however, it should be noted that intraabdominal AVM can cause hemorrhage, and minimally invasive laparoscopic surgery should be considered as a diagnostic treatment option.