Arteriovenous malformation causing ileocecal variceal bleeding in liver cirrhosis: case report and review of the literature

Abstract

Varices that occur at sites other than the esophagogastric area are termed ectopic varices. An ileal varix is a very rare cause of lower gastrointestinal bleeding. Although ileal varices are generally associated with prior intra-abdominal surgery and adhesions, an arteriovenous malformation (AVM) in the ileocecal area can cause ileal varices and bleeding in patients with portal hypertension who have not received previous intra-abdominal surgery, which is due to an intestinal or colonic AVM dilating the collateral veins and further aggravating portal hypertension. Surgical treatment should be considered in patients with massive ectopic variceal bleeding. We report a case of massive ileocecal variceal bleeding associated with an AVM that occurred in a patient with alcoholic liver cirrhosis.

Keywords: Arteriovenous malformation; Ileocecal varix; Portal hypertension.

Fig. 1

Colonoscopic view of ileoceal variceal bleeding performed for a Dieulafoy lesion due to spurting bleeding at the terminal ileum. Hemoclips are applied.

Fig. 2

(A) Selective angiography of the superior mesenteric artery (SMA) showing dilated tortuous veins (black arrow) in the delayed phase. White arrow: superior mesenteric vein (SMV). (B) Early filling of the dilated draining veins. Black arrow: SMA, white arrow: SMV. (C) Suspicious contrast extravasation (black arrow) in distal portion of the right colic branch, for which embolization is performed. White arrow: right colic artery.

Fig. 3

Gross specimen shows a dilated submucosal vein in the resected ileum.

Fig. 4

(A) Irregularly enlarged angiodysplastic vessels with rupture and hematoma formation in the submucosa. (B) Thick- and thin-walled vascular channels (black and white arrows, respectively) in the submucosa (hematoxylin & eosin stain; ×10). (C) Internal elastic fibers (black arrow) in thick artery-like vessels (elastin stain; ×100).