Tehran University Medical Journal (Dec 2023)
Arteriovenous malformation of the small intestine causing lower gastrointestinal bleeding: a case report
Abstract
Background: Lower gastrointestinal bleeding, a symptom that can become the cause of a life-threatening condition, has a 33 per 100,000 prevalence. The origin of lower gastrointestinal bleeding in most cases is the small intestine, colon, or anorectal parts. Surgical consultation in patients with gastrointestinal bleeding is one of the most necessary measures so that the patient can be treated at the appropriate stage with a greater chance of success before reaching shock. In the case of uncontrolled gastrointestinal bleeding, surgery is recommended as soon as possible when endoscopic and radiological treatments are not possible or effective. Case Presentation: In this article, we present a case of uncontrolled lower gastrointestinal bleeding in a 50-year-old patient who was admitted to Imam Khomeini Hospital in Tehran on December 15, 2021. Despite performing appropriate paraclinic measures such as sonography, endoscopy, and colonoscopy the gastrointestinal bleeding origin was not determined. On the other hand, our investigations showed that she had liver cirrhosis. Due to the instability of the patient's condition due to continued lower gastrointestinal bleeding, the medical team decided to perform surgery. The surgeon noticed that the origin of the bleeding was a vascular entanglement at the small intestine-navel junction, and the procedure involved segmental excision of the small intestine. Conclusion: In cirrhotic patients, lower gastrointestinal bleeding is an emergency condition, and if the source of the bleeding is not accessible via endoscopy or colonoscopy, diagnosing and treatment become extremely difficult. Computed tomography angiography and subsequent surgery are effective approaches for diagnosing and treating these conditions. When lower gastrointestinal bleeding is uncontrolled, exploratory laparotomy should be considered. Due to the unknown origin of bleeding, exploratory laparotomy may not be successful, so using endoscopy during surgery can help to diagnose the location of the lesion in these cases; However, in some cases despite all measures, the source of bleeding may not be determined, in these case the rate of rebleeding after surgery will be high.
