Intraoperative identification of Arteriovenous Malformation of the Small Intestine using a Microcatheter, a Case Report.

Abstract

Small intestinal AVMs with massive bleeding are relatively rare, and it is difficult to localize bleeding sites precisely by inspection and palpation during surgery, even by intraoperative mesenteric angiography. We report a 70-year-old woman with massive intestinal bleeding caused by an AVM in the jejunum. We inserted and maintained a microcatheter adjacent to the bleeding site by selective mesenteric catheterization immediately before surgery. This enabled us to localize the lesion by catheter palpation during surgery, and to precisely confirm the 5×5mm AVM by transillumination holding the intestine up to the light. Angiography of the specimen showed abnormal capillary beds, a dilated feeding artery, and a large drainage vein that flowed back early. According to the Japanese literature, most AVMs are generally resected at an approximate site by intraoperative angiography, and long intestines are resected unnecessarily. Some reports describe inserting and maintaining a microcoil near the lesion by mesenteric angiography, but no sure method has yet been established to confirm the lesion during surgery as we were able to achieve in intraoperative precise localization.