Arteriovenous Malformation in Small Intestine as Atypical Etiology of Lower Gastro-intestinal Bleeding – A Case Report

Česká verzia

Authors: T. Toporcer; M. Stančáková; M. Švajdler ^*; L. Lakyová; J. Radoňak
Authors place of work: I. chirurgická klinika, Lekárska fakulta Univerzity P. J. Šafárika, Košice, Slovenská republika, prednosta: prof. MUDr. Jozef Radoňak, CSc. ; Oddelenie patológie FN L. Pasteura Košice, Slovenská republika ^*
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 6, s. 370-374.
Category: Monothematic special - Original

Summary

Lower gastrointestinal tract bleeding (LGIB) is the acute abdomen, defined as gastrointestinal tract bleeding under the ligament of Treitz.

We present the case report of patient iteratively hospitalized because of repeated LGIB. There were performed gastrofibroscopy, colonoscopy and capsule endoscopy, without the bleeding localization. Scintigraphy and computer tomography showed the origin of bleeding in terminal small intestine; the computer tomography diagnosed the arteriovenous malformation in this area. During laparotomy the resection of 120 cm of terminal small intestine was performed with end-to-end anastomosis. The recurrence of bleeding was not diagnosed.

LGIB takes about 0.
5% of acute hospitalization at surgery departments. After the stabilization of vital functions, the exclusion of the upper gastrointestinal tract bleeding and fast gastrointestinal tract preparation, the urgent colonoscopy is recommended. In case of nonsuccesfulle colonoscopy, the most of authors recommend angiography, capsule endoscopy and double-balloon endoscopy. The conservative management is adequate in more than 2/3 of patients; in part of them the intervention during colonoscopy is possible. Surgical intervention with gastrointestinal tract resection is performed in less than 17% of patients. The urgent surgery is needed in 4.7% of patients. All the diagnostic and curative interventions have greater success and should be performed during the acute bleeding.

Key words:
lower gastrointestinal bleeding – arteriovenous malformation

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