Abstract
We report a case of massive melena due to arteriovenous malformation in the sigmoid colon, treated with spongel embolization. A 61-year-old man, with a 6-year history of chronic hemodialysis, developed massive melena. Gastroduodenal fiberscopy revealed no bleeding site in the stomach or duodenum. Colonoscopic examination revealed only petechiae in the sigmoid region. Angiodysplasia of the gut was suspected. Angiography showed dilatation of the vasa recta and abnormal vasculature spreading between the descending colon and sigmoid colon.
Arteriovenous malformation was diagnosed. Ultraselective embolization was performed using spongel, at the site of the arteriovenous malformation, and the melena stopped within 3 days. We conclude that, while gastrointestinal bleeding is a common complication, the possibility of arteriovenous malformation in the gut should be recognized as a possible cause of gastrointestinal bleeding in hemodialysis patients.
