Arteriovenous Malformation in Small Intestine as Atypical Etiology of Lower Gastro-intestinal Bleeding – A Case Report
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
Zdroje
1. Zuccaro, G. Jr. Management of the adult patient with acute lower gastrointestinal bleeding. American College of Gastroenterology. Practice Parameters Committee. The American journal of gastroenterology, 1998, roč. 93, s. 1202–1208.
2. Eisen, G. M., Dominitz, J. A., Faigel, D. O., et al. An annotated algorithmic approach to acute lower gastrointestinal bleeding. Gastrointestinal endoscopy, 2001, roč. 53, s. 859–863.
3. Davila, R. E., Rajan, E., Adler, D. G., et al. ASGE Guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointestinal endoscopy, 2005, roč. 62, s. 656–660.
4. Gayer, C., Chino, A., Lucas, C., et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery, 2009, roč. 146, s. 600–606; discussion 606–607.
5. Lanas, A., Garcia-Rodriguez, L. A., Polo-Tomas, M., et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. The American journal of gastroenterology, 2009, roč. 104, s. 1633–1641.
6. Fireman, Z., Friedman, S. Diagnostic yield of capsule endoscopy in obscure gastrointestinal bleeding. Digestion, 2004, roč. 70, s. 201–206.
7. Wong Kee Song, L. M., Baron, T. H. Endoscopic management of acute lower gastrointestinal bleeding. The American journal of gastroenterology, 2008, roč. 103, s. 1881–1887.
8. Jensen, D. M., Machicado, G. A. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding. Routine outcomes and cost analysis. Gastrointestinal endoscopy clinics of North America, 1997, roč. 7, s. 477–498.
9. Machicado, G. A., Jensen, D. M. Endoscopic diagnosis and treatment of severe lower gastrointestinal bleeding. Indian J. Gastroenterol., 2006, roč. 25, Suppl. 1, s. S43–51.
10. Farrands, P. A., Taylor, I. Management of acute lower gastrointestinal haemorrhage in a surgical unit over a 4-year period. Journal of the Royal Society of Medicine, 1987, roč. 80, s. 79–82.
11. Al Qahtani, A. R., Satin, R., Stern, J., et al. Investigative modalities for massive lower gastrointestinal bleeding. World journal of surgery, 2002, roč.: 26, s. 620–625.
12. Silver, A., Bendick, P., Wasvary, H. Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage. American journal of surgery, 2005, roč. 189, s. 361–363.
13. Carlo, J. T., DeMarco, D., Smith, B. A., et al. The utility of capsule endoscopy and its role for diagnosing pathology in the gastrointestinal tract. American journal of surgery, 2005, roč. 190, s. 886–890.
14. Pennazio, M., Santucci, R., Rondonotti, E., et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology, 2004, roč. 126, s. 643–653.
15. Triester, S. L., Leighton, J. A., Leontiadis, G. I., et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. The American journal of gastroenterology, 2005, roč. 100, s. 2407–2418.
16. Jacobson, T. B., Kolade, V. O. Massive GI bleeding in a patient with 2 small AVMs in the small intestine: a case report. Cases journal, (in press)
17. Lewis, B. S. Obscure GI bleeding in the world of capsule endoscopy, push, and double balloon enteroscopies. Gastrointestinal endoscopy, 2007, roč. 66, s. S66–68.
18. Hotta, K., Yoshida, K. Bleeding angiodysplasia of the jejunum without a visible vessel. Endoscopy, 2009, roč. 41 Suppl 2, s. E253.
19. Richter, J. M., Christensen, M. R., Kaplan, L. M., et al. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage. Gastrointestinal endoscopy, 1995, roč. 41, s. 93–98.
20. Edelman, D. A., Sugawa, C. Lower gastrointestinal bleeding: a review. Surgical endoscopy, 2007, roč. 21, s. 514–520.
21. Green, B. T., Rockey, D. C. Lower gastrointestinal bleeding-management. Gastroenterology clinics of North America, 2005, roč. 34, s. 665–678.
22. Chaudhry, V., Hyser, M. J., Gracias, V. H., et al. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. The American surgeon, 1998, roč. 64, s. 723–728.
23. Tan, K. K., Wong, D., Sim, R. Superselective embolization for lower gastrointestinal hemorrhage: an institutional review over 7 years. World journal of surgery, 2008, roč. 32, s. 2707–2715.
24. Longstreth, G. F. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. The American journal of gastroenterology, 1997, roč. 92, s. 419–424.
25. Leitman, I. M., Paull, D. E., Shires, G. T. 3rd. Evaluation and management of massive lower gastrointestinal hemorrhage. Annals of surgery, 1989, roč. 209, s. 175–180.
26. Schuetz, A., Jauch, K. W. Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Langenbeck‘s archives of surgery / Deutsche Gesellschaft fur Chirurgie, 2001, roč. 386, s. 17–25.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2010 Číslo 6
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Interbody Spacers in the Treatment of Cervical Spine Disorders
- Laparoscopic Hernioplasty TAPP in Treatment of Groin Hernia – 10 Years Experience
- Abdominal Catastrophe – Surgeon’s View
- Quality of Life after Gastrectomy