Embolization of a Duodenal Arteriovenous Malformation in Hereditary Hemorrhagic Telangiectasia: Case Report and Review of the Literature

Abstract

A 68-year-old man with hereditary hemorrhagic telangiectasia presented with recurrent, intermittent gastrointestinal hemorrhage. Transfusion of a total of 27 units of red blood cells was required over the three months before admission. Upper and lower endoscopy did not reveal a source of bleeding and a technetium-labelled red blood cell scan was noncontributory. Angiography demonstrated a duodenal arteriovenous malformation originating from a superior mesenteric artery branch. Embolization of the arteriovenous malformation was performed with resolution of gastrointestinal hemorrhage and reduced requirement for blood transfusion. The utility of trans-catheter embolization in the management of duodenal arteriovenous malformations in hereditary hemorrhagic telangiectasia is discussed.

Evidence of Small-Bowel Involvement in Hereditary Hemorrhagic Telangiectasia: a Capsule-Endoscopic Study

“…The difficulty of investigating the source of small-bowel bleeding has for many years complicated this issue; small-bowel telangiectases are difficult to detect using radiography, conventional endoscopy, angiography, or scintigraphy scanning. The literature data (including only case reports) show that technetium-labeled red blood cell scanning and arteriography are ineffective in detecting small-bowel lesions [26]. However, the advent of CE now appears to have overcome these technical problems [19 ± 22].…”

Successful endoscopic management of a large duodenal arteriovenous malformation using an over-the-scope clip

“…The patient has since not reported any further bleeding episodes and has remained stable with no requirement for iron infusions during a 10month follow-up period. Large duodenal AVMs are rare and previous case reports have described successful management of bleeding lesions with angiographic embolization [1,2] although this approach has not been universally effective [3], nor has laparoscopic ligation of the feeding branch of the gastroduodenal artery [3]. Band ligation has not been previously described but carries the risk of delayed bleeding from post-ligation ulcer development and glue injection has only provided temporary hemostasis in another case report [3].…”