Zhang Zhi-Wei, Chen Jun-Qiang
Department of Gastrointestinal Surgery, Jinhua Central Hospital, Jinhua, China.
Front Med (Lausanne). 2025 Aug 21;12:1621874. doi: 10.3389/fmed.2025.1621874. eCollection 2025.
Chronic intestinal bleeding caused by vascular malformations is uncommon. Locating these small intestinal vascular malformations with precision during surgery remains a challenge. With the rapid development of digital subtraction angiography (DSA), the detection of small intestinal vascular malformations has become easier. However, heterochronous resection of the diseased small intestine may still have negative results, even with the accurate location of the malformed vessels because of the quick excretion of the contrast agent.
A 69-year-old woman presented with recurrent melena lasting for over 3 years, including a recent aggravation 2 days prior to admission. DSA revealed abnormal contrast uptake in the distal part of the first branch of the left superior mesenteric artery. Enhanced computed tomography (CT) scan confirmed the presence of vascular malformations in the small intestine. DSA and methylene blue staining were further utilized in a hybrid operating room to locate the vascular malformation of the small intestine. Laparoscopy-assisted synchronous resection of the stained intestine was performed simultaneously, effectively resolving the intestinal bleeding associated with the malformed vessels. The patient was discharged on postoperative day 5, without complication. She experienced no complications, such as intestinal fistula and hematochezia, at the 6-month follow-up.
With increased experience, laparoscopy and methylene blue staining angiography may offer a safe and feasible method for synchronous resection of small intestine vascular malformations.
血管畸形引起的慢性肠道出血并不常见。在手术中精确找到这些小肠血管畸形仍然是一项挑战。随着数字减影血管造影（DSA）的快速发展，小肠血管畸形的检测变得更加容易。然而，即使畸形血管定位准确，由于造影剂排泄迅速，对病变小肠进行异时性切除仍可能出现阴性结果。
一名69岁女性，反复出现黑便3年多，包括入院前2天病情近期加重。DSA显示肠系膜上动脉左支第一分支远端造影剂摄取异常。增强计算机断层扫描（CT）证实小肠存在血管畸形。在杂交手术室进一步利用DSA和亚甲蓝染色来定位小肠血管畸形。同时进行腹腔镜辅助同步切除染色肠段，有效解决了与畸形血管相关的肠道出血问题。患者术后第5天出院，无并发症。6个月随访时未出现肠瘘、便血等并发症。
随着经验的增加，腹腔镜和亚甲蓝染色血管造影术可能为同步切除小肠血管畸形提供一种安全可行的方法。
