Laparoscopic resection for rectal arteriovenous malformation: a case report

Shoko Tei; Keisuke Noda; Tetsuro Tominaga; Yuma Takamura; Hiroki Katayama; Shintaro Hashimoto; Mariko Yamashita; Yuki Hara; Rin Yamaguchi; Takashi Nonaka; Keitaro Matsumoto

doi:10.18203/2349-2902.isj20260461

Authors

Shoko Tei Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Keisuke Noda Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Tetsuro Tominaga Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Yuma Takamura Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Hiroki Katayama Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Shintaro Hashimoto Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Mariko Yamashita Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
Yuki Hara Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
Rin Yamaguchi Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
Takashi Nonaka 1Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan; Department of Surgery, Divisions of Colorectal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan; Minimally Invasive Surgery Center, Nagasaki University Hospital, Nagasaki, Japan
Keitaro Matsumoto Department of Surgery, Divisions of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan

DOI:

https://doi.org/10.18203/2349-2902.isj20260461

Keywords:

Arteriovenous malformation, Rectum, Surgery

Abstract

Arteriovenous malformation (AVM) is a vascular anomaly characterized by direct communication between arteries and veins without intervening capillaries. A 67-year-old man with no history of surgery, trauma, or gastrointestinal bleeding was incidentally found to have a rectal AVM during follow-up imaging after endoscopic resection of a rectal neuroendocrine tumour. Contrast-enhanced computed tomography revealed multiple dilated veins surrounding the rectum and sigmoid colon, with shunting from the inferior mesenteric artery into a dilated venous sac and subsequent drainage into the inferior mesenteric vein. Colonoscopy identified a bulbous, dilated vascular proliferation 15–25 cm from the anal verge. Treatment was considered necessary due to the potential for future rupture. Interventional radiology was deemed unsuitable because of the extensive nature of the lesion, and the patient underwent laparoscopic low anterior resection with early ligation of the inferior mesenteric artery and vein. The postoperative course was uneventful, discharged on postoperative day eight.

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References

Meyer CT, Troncale FJ, Galloway S, Sheahan DG. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine. 1981;60(1):36-48. DOI: https://doi.org/10.1097/00005792-198101000-00004

Cho SK, Do YS, Shin SW, Kim DI, Kim YW, Park KB, et al. Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther. 2006;13(4):527-38. DOI: https://doi.org/10.1583/05-1769.1

Jubashi A, Yamaguchi D, Nagatsuma G, Inoue S, Tanaka Y, Yoshioka W, et al. Successful retrograde transvenous embolization under balloon occlusion for rectal arteriovenous malformation. Clin J Gastroenterol. 2021;14(2):594-8. DOI: https://doi.org/10.1007/s12328-020-01335-w

Shiraishi T, Kunizaki M, Takaki H, Horikami K, Yonemitsu N, Ikari H. A case of arteriovenous malformation in the inferior mesenteric artery region resected surgically under intraoperative indocyanine green fluorescence imaging. Int J Surg Case Rep. 2022;92:106831. DOI: https://doi.org/10.1016/j.ijscr.2022.106831

Hervías D, Turrión JP, Herrera M, Navajas León J, Pajares Villarroya R, Castillo P, et al. Diffuse cavernous hemangioma of the rectum: an atypical cause of rectal bleeding. Rev Esp Enferm Dig. 2004;96(5):346-52. DOI: https://doi.org/10.4321/S1130-01082004000500008

Capron JP, Gineston JL, Remond A, Lallement PY, Delamarre J, Revert R, et al. Inferior mesenteric arteriovenous fistula associated with portal hypertension and acute ischemic colitis. Successful occlusion by intraarterial embolization with steel coils. Gastroenterology. 1984;86(2):351-5. DOI: https://doi.org/10.1016/0016-5085(84)90422-0

Djouhri H, Arrivé L, Bouras T, Martin B, Monnier-Cholley L, Tubiana JM. Diffuse cavernous hemangioma of the rectosigmoid colon: imaging findings. J Comput Assist Tomogr. 1998;22(6):851-5. DOI: https://doi.org/10.1097/00004728-199811000-00002

Moore JD, Thompson NW, Appelman HD, Foley D. Arteriovenous malformations of the gastrointestinal tract. Arch Surg. 1976;111(4):381-9. DOI: https://doi.org/10.1001/archsurg.1976.01360220077013

Cotzias E, Rehman SF, Arsalani Zadeh R, Smith D. Conservative management of diffuse cavernous haemangioma of the sigmoid and rectum. Ann R Coll Surg Engl. 2020;102(1):e1-3. DOI: https://doi.org/10.1308/rcsann.2019.0088

Parashette KR, Cuffari C. Sclerotherapy of rectal hemangiomas in a child with Klippel-Trenaunay-Weber syndrome. J Pediatr Gastroenterol Nutr. 2011;52(1):111-2. DOI: https://doi.org/10.1097/MPG.0b013e3181eb6842