A Case of the Problematic Gastrointestinal Bleeding in Treatment Due to Arteriovenous Malformation of the Jejunum

Shuuhei Komatsu, Hiroyuki Naitoh, Hiroki Tamura, Eiji Mekata, Akira Kawaguchi, Hajime Abe, Yoshihiro Endo, Yoshimasa Kurumi, Kazuyoshi Hanazawa and Tohru Tani

Department of Surgery, Shiga University School of Medicine

We report a case of arteriovenous malformation (AVM) of the jejunum with repeated intestinal bleeding, in which angiography was useful in localizing the responsible lesion. A 75-year-old woman reporting repeated bloody stool and anemia underwent initial surgery for a small polyp and multiple diverticulosis of the ileocecal lesion, detected by routine radiography. One month later, however, she again reported bloody stool for which routine gastrointestinal examinations and radionuclide blood scintigraphy failed to show the bleeding site. We therefore conducted selective mesenteric angiography that showed AVM at the jejunal branch. Prior to surgery, we catheterized for the feeding vessels. On laparotomy, we identified the segment by injection of methylene blue through the catheter, and resected the localized jejunal segment. The postoperative course was uneventful. Arteriovenous malformation should thus be considered as leading to repeated intestinal bleeding of unknown origin. Angiography may provide useful information in the diagnosis of this disease and intraoperative localization of the segment.

Key words
arteriovenous malformation (AVM), intestinal bleeding, angiography

Reprint requests
Shuuhei Komatsu Department of Surgery, Kyoto Daiichi Red Cross Hospital 15-749 Honmachi, Higashiyamaku Kyoto, 605-0981 JAPAN

Accepted
November 27, 2002

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