Kurata Yoshihiro, Hayano Koichi, Matsusaka Keisuke, Mamiya Hisashi, Uesato Masaya, Murakami Kentaro, Kano Masayuki, Toyozumi Takeshi, Matsumoto Yasunori, Suito Hiroshi, Isozaki Tetsuro, Ohira Gaku, Hayashi Hideki, Matsubara Hisahiro
Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan.
Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba City, Japan.
Surg Case Rep. 2022 Jan 4;8(1):4. doi: 10.1186/s40792-021-01356-8.
Arteriovenous malformation (AVM) of the gastrointestinal (GI) tract can cause bleeding. The treatment choice for GI tract AVM is surgical resection of the involved bowel segment with complete resection of the nidus. The AVM formed in the duodenum or pancreatic head could also cause gastrointestinal bleeding, and there are several reports of pancreaticoduodenectomy as its treatment. However, if the area of AVM can be accurately identified during surgery, it may be possible to completely resect the AVM while preserving the organ. We report a case of duodenal AVM in a patient successfully treated with a subtotal stomach-preserving duodenal bulb resection using intraoperative indocyanine green (ICG) angiography technique.
An 18-year-old man was diagnosed with duodenal AVM after several examinations for anemia and was referred to our hospital for further treatment. Preoperative imaging studies showed that the inflow vessels of this duodenal AVM were the inferior pyloric artery and the superior duodenal artery, and the AVM was localized to the duodenal bulb. Thereafter, stomach-preserving duodenal bulb resection preceded by ligation of the inflow vessels was performed. During the surgery, ICG angiography clearly demonstrated the area, where the nidus was distributed, and a duodenal bulb resection with complete resection of the AVM was successfully performed. There was no recurrence at the 6-month follow-up.
Intraoperative ICG angiography was a useful procedure for precise identification of the AVM of the GI tract.
胃肠道动静脉畸形（AVM）可导致出血。胃肠道AVM的治疗选择是手术切除受累肠段并完全切除病灶。十二指肠或胰头形成的AVM也可引起胃肠道出血，有几篇关于胰十二指肠切除术作为其治疗方法的报道。然而，如果在手术中能够准确识别AVM的区域，则有可能在保留器官的同时完全切除AVM。我们报告一例十二指肠AVM患者，采用术中吲哚菁绿（ICG）血管造影技术成功进行了保留胃窦的十二指肠球部次全切除术。
一名18岁男性在多次贫血检查后被诊断为十二指肠AVM，并转诊至我院接受进一步治疗。术前影像学检查显示，该十二指肠AVM的流入血管为幽门下动脉和十二指肠上动脉，AVM位于十二指肠球部。此后，在结扎流入血管后进行了保留胃窦的十二指肠球部切除术。手术过程中，ICG血管造影清晰地显示了病灶分布区域，成功进行了十二指肠球部切除术并完全切除了AVM。6个月随访时无复发。
术中ICG血管造影是精确识别胃肠道AVM的有用方法。
