Hyo Takahiko, Matsuda Kenji, Tamura Koichi, Iwamoto Hiromitsu, Mitani Yasuyuki, Mizumoto Yuki, Nakamura Yuki, Yamaue Hiroki
Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan.
Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan.
Int J Surg Case Rep. 2020;74:201-204. doi: 10.1016/j.ijscr.2020.08.038. Epub 2020 Aug 29.
Approximately 5 % of gastrointestinal bleeding is due to small intestinal bleeding. Bleeding from small intestinal arteriovenous malformation (AVM) is rare, with few reported cases. Finding the precise location and boundary is difficult during surgery, so we tried using intravenous injection of indocyanine green (ICG). Use of ICG in a case of intestinal AVM is reported here for the first time, with a review of the literature.
A 48-YEAR-old male had anemia and low hemoglobin level (Hb) 4.0 g/dL. After several examinations including small intestinal endoscopy, capsule endoscopy and angiography, AVM was identified. Preoperative diagnosis was AVM caused by branching of the ileocolic artery (ICA). Meanwhile, macroscopy showed engorgement of the vein in the ileum wall and mesentery, the boundary of which was unclear. We performed intra-operative monitoring with ICG. After intravenous injection of ICG, the boundary and location became clear. The abnormal ileum was 30 cm in length and located 130 cm from the Treitz ligament, which was different from angiographic findings. Pathology showed dilated vascular hyperplasia of the submucosa, tunica and chorionic membrane. Final diagnosis was ileum AVM. The postoperative course was uneventful and gastrointestinal bleeding stopped.
ICG monitoring aided diagnosis and treatment of Ileum AVM, which was treated by laparoscopic surgery.
约5%的胃肠道出血是由小肠出血引起的。小肠动静脉畸形（AVM）出血较为罕见，报道的病例很少。手术过程中难以找到精确的位置和边界，因此我们尝试使用静脉注射吲哚菁绿（ICG）。本文首次报道了ICG在一例小肠AVM病例中的应用，并对相关文献进行了回顾。
一名48岁男性患有贫血，血红蛋白水平（Hb）低至4.0g/dL。经过包括小肠内镜检查、胶囊内镜检查和血管造影在内的多项检查后，确诊为AVM。术前诊断为回结肠动脉（ICA）分支引起的AVM。同时，肉眼可见回肠壁和肠系膜静脉充血，边界不清。我们使用ICG进行术中监测。静脉注射ICG后，边界和位置变得清晰。异常回肠长30cm，距Treitz韧带130cm，与血管造影结果不同。病理显示黏膜下层、中膜和绒毛膜血管增生扩张。最终诊断为回肠AVM。术后病程顺利，胃肠道出血停止。
ICG监测有助于回肠AVM的诊断和治疗，该病例采用腹腔镜手术治疗。
