Resection of the Arteriovenous Malformation of the Jejunum with the Use of Laparoscopy-Assisted Surgery Combined with Marking Coil

Takaaki Yamamoto, Shigeyuki Kawachi, Hideyuki Kawahara, Masahiro Hamaya, Takashi Sakurai, So Inoue, Shin Takayama and Tadashi Hara

Division of Surgery, Kawasaki Ida Municipal Hospital

A 65-year-old woman was admitted to our hospital because of repeated tarry stools. Upper and lower intestinal examination, including panendoscopy, upper gastrointestinal series, small intestinal x-ray, barium enema and colonoscopy, revealed no source of bleeding. A superior mesenteric arteriogram demonstrated a dilated draining vein from early arterial phase to late vonous phase, leading to the diagnosis of arteriovenous malformation (AVM). A microcoil was placed within the artery near the AVM lesion as a marker by the selective angiography technique in order to identify the lesion during surgery. The operation was started under laparoscopy. Since the laparoscopy did not enable us to find the lesion, an intraoperative fluoroscope was introduced. With the assistance of the laparoscopy, the lesion bearing jejunum, 33 cm in length, was pulled out of the abdomen through the minilaparotomy and resected. Gross observation of the resected specimen revealed a circular brownish discolored area measuring 5 cm in length. Histological examination demonstrated the dilated vessels mainly in the submucosal layer. The postoperative course was uneventful and she was discharged from the hospital on the 11th postoperative day. We concluded that the laparoscopic surgery combined with the angiographic technique of placing a microcoil is one of the effective strategies for the treatment of intestinal AVM.

Key words
intestinal arteriovenous malformation, marking coil inserted with angiography, laparoscopic surgery with fluoroscopy

Reprint requests
Takaaki Yamamoto Division of Surgery, Kawasaki Ida Municipal Hospital 2-27-1 Ida, Nakaharaku, Kawasaki, 211-0035 JAPAN

Accepted
January 27, 1999

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