Diagnostic and Therapeutic Tricks in a Rare Case of Pediatric Ileal Congenital Arteriovenous Malformation

Abstract

C ongenital arteriovenous malformations (AVMs) are not usually considered initially in the diagnostic workup of a pediatric melena (1). After excluding conditions requiring nonoperative management, conventional endoscopic evaluations and radionuclide scans are, in most patients, able to define the site of bleeding and address the type of operative treatment. Furthermore, capsule endoscopy or double-balloon enteroscopy can provide additional information in doubtful cases, even of pediatric age (2). Nevertheless, there are some cases in which the diagnosis remains difficult, setting up an ''obscure melena'' requiring additional investigations. AVMs are rare in children, usually small, single, predominantly located in the rectum and descending colon, and relatively uncommon in the small bowel (3). An exceedingly rare case of congenital AVM arising from the ileal branch of the ileocolic artery in a baby girl is described as well as the original method of angiographic wire placement, as an intraoperative locating mark, to help surgical resection planning.