Shrestha Sajan, Pradhan Susan, Kc Ajay, Shrestha Sujan, Kansakar Prasan
Gastrointestinal and General Surgery/General Surgery, Pokhara Academy of Health Sciences, Pokhara, NPL.
Colorectal Surgery, Clinic NEO, Kathmandu, NPL.
Cureus. 2023 Jun 4;15(6):e39940. doi: 10.7759/cureus.39940. eCollection 2023 Jun.
Arteriovenous malformations of the small intestine are an important differential in cases of occult gastrointestinal bleeding. Localization of the source of gastrointestinal bleeding can be a difficult task, especially in resource-limited settings where balloon-assisted enteroscopy or video capsule endoscopy are unavailable. We herein report the use of intraoperative enteroscopy to help localize and resect a short bowel segment containing a bleeding arteriovenous malformation of the jejunum in a 50-year-old man who presented with hematochezia and pallor leading to hemorrhagic shock. Esophagogastroduodenoscopy and colonoscopy showed no abnormalities, but a contrast-enhanced computed tomography scan of the abdomen revealed a contrast blush in the proximal jejunum. Angiography with coil embolization failed to control his symptoms, and he underwent exploratory laparotomy with intraoperative enteroscopy to try and localize the bleeding, followed by resection of the diseased segment and anastomosis of the small bowel, which led to the successful resolution of the patient's issues.
小肠动静脉畸形是隐匿性胃肠道出血病例中的一个重要鉴别诊断。胃肠道出血源的定位可能是一项艰巨的任务，尤其是在资源有限的环境中，那里无法进行气囊辅助小肠镜检查或视频胶囊内镜检查。我们在此报告了在一名50岁男性患者中使用术中小肠镜检查来帮助定位并切除一段含有空肠出血性动静脉畸形的短肠段。该患者表现为便血和面色苍白，导致失血性休克。食管胃十二指肠镜检查和结肠镜检查均未发现异常，但腹部增强计算机断层扫描显示空肠近端有造影剂外溢。经导管栓塞术未能控制其症状，于是他接受了剖腹探查术及术中小肠镜检查以试图定位出血部位，随后切除病变肠段并进行小肠吻合，从而成功解决了患者的问题。
