Arteriovenous Malformation of the Jejunum, Causing Massive Gastrointestinal Bleeding, Treated With Intraoperative Enteroscopy Guidance: A Case Report

Abstract

Arteriovenous malformations of the small intestine are an important differential in cases of occult gastrointestinal bleeding. Localization of the source of gastrointestinal bleeding can be a difficult task, especially in resource-limited settings where balloon-assisted enteroscopy or video capsule endoscopy are unavailable. We herein report the use of intraoperative enteroscopy to help localize and resect a short bowel segment containing a bleeding arteriovenous malformation of the jejunum in a 50-year-old man who presented with hematochezia and pallor leading to hemorrhagic shock. Esophagogastroduodenoscopy and colonoscopy showed no abnormalities, but a contrast-enhanced computed tomography scan of the abdomen revealed a contrast blush in the proximal jejunum. Angiography with coil embolization failed to control his symptoms, and he underwent exploratory laparotomy with intraoperative enteroscopy to try and localize the bleeding, followed by resection of the diseased segment and anastomosis of the small bowel, which led to the successful resolution of the patient's issues.

Keywords: acute gastrointestinal bleed; bowel disorder; hematochezia; intraoperative enteroscopy; jejunal arteriovenous malformation; middle gastrointestinal bleed; obscure gi bleeding; operative management.

Figure 1. Contrast blush noted in proximal jejunum on CECT abdomen/pelvis

Figure 2. Intraoperative enteroscopy showing pooling of blood in the proximal jejunum

Figure 3. Cut section shows a small vascular lesion in the specimen

Figure 4. Histopathology of a segment of the jejunum showing arterio-venous malformation

Blue arrow: vein. Red arrow: artery.