Intraoperative localization of arteriovenous malformation of a jejunum with combined use of angiographic methods and indocyanine green injection: Report of a new technique

Abstract

HighlightsThe localization of small intestine sources of obscure gastrointestinal bleeding is a challenge.The use of indocyanine green (ICG) is effective in aiding intraoperative localization.The ICG fluorescence imaging can visualize the lesion as an arteriovenous malformation.

Small intestinal arteriovenous malformation treated by laparoscopic surgery using intravenous injection of ICG: Case report with literature review

“…Table 1 shows reported cases of small intestinal AVM (18 cases) [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. Age of onset is wide-ranging (19 months to 95-years).…”

“…Hybrid therapy using surgery and IVR was recently reported [ 5 ], but, it is sometimes difficult to ascertain the location and decide the resection line during surgery. Several case reports have showed the usefulness of marking clips in endoscopy, X-ray and angiography during operations [ 4 , 5 , 8 , 16 ]. Ono, et al reported the use of selective angiography and ICG injection through the catheter during surgery [ 8 ].…”

“…Several case reports have showed the usefulness of marking clips in endoscopy, X-ray and angiography during operations [ 4 , 5 , 8 , 16 ]. Ono, et al reported the use of selective angiography and ICG injection through the catheter during surgery [ 8 ]. It is sometimes difficult, however, to determine the border.…”

Laproscopic treatment for small bowel bleeding after detection by double-balloon endoscopy: A case report

“…Prior to laparoscopic resection, the localization of the responsible area might be a significant consideration when the lesion is invisible. There have been some reports about localizing procedures following selective mesenteric angiography, such as methylene blue injection [10], placement of metallic coil [2], and intraoperative indocyanine green injection via the microcatheter and fluorescent scope observation [11]. Unlike these procedures, endoscopic marking with DBE enables intraluminal detection and laparoscopic observation from the serosal side without an X-ray device [6].…”

Laparoscopic resection of idiopathic jejunal arteriovenous malformation after metallic coil embolization

“…Defreyne et al reported the intraoperative use of a methylene blue dye injection to visualize the location of small intestine AVM [ 9 ]. Recently, Ono et al reported that an intraoperative indocyanine green dye injection and examination with a fluorescent scope could localize jejunal AVMs [ 10 ]. Although these techniques described above are useful in open surgery, they are sometimes difficult to be performed and observed during laparoscopic surgery with limited view area on a screen.…”