J Korean Med Sci.  2007 Aug;22(4):746-749. 10.3346/jkms.2007.22.4.746.

Recurrent Lower Gastrointestinal Bleeding from Congenital Arteriovenous Malformation in the Terminal Ileum Mimicking Intestinal Varicosis: A Case Report

• Cheon JH
• Song HJ
• Kim JS
• Park KJ
• Kim WH
• Jung HC
• Song IS

• KMID: 1127099
• DOI: http://doi.org/10.3346/jkms.2007.22.4.746

Abstract

We report on an exceptional vascular cause of gastrointestinal hemorrhage. A 30-yr-old man was admitted because of recurrent hematochezia. Colonoscopy showed circumferential, erythematous, and nodular vascular distensions with hematocystic spots in the terminal ileum resembling varicosis and subsequent computed tomography with 3-dimensional angiographic reconstruction revealed a vascular architecture around the terminal ileum. No other potential source of bleeding was identified. The patient was treated by ileocecectomy and the final diagnosis was of an arteriovenous malformation confined to the terminal ileum. He has been followedup without a further hemorrhagic episode.

Keyword

Congenital; Arteriovenous Malformation; Ileum; Varix; Bleeding

MeSH Terms

Adult
Arteriovenous Malformations/complications/*pathology
Diagnosis, Differential
Gastrointestinal Hemorrhage/etiology/*pathology
Humans
Ileum/*abnormalities
Intestines/*blood supply
Male
Recurrence
Varicose Veins/etiology/*pathology

Figure

• 

  Fig. 1 Colonoscopic view of the arteriovenous malformation. This image shows circumferential, erythematous, tortuous vascular distensions with hematocystic spots in the terminal ileum, resembling the varices seen in the esophagus of patients with portal hypertension.

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  Fig. 2 Computed tomography (CT) scan finding with 3-dimensional angiographic reconstruction. The high-density architecture encasing the terminal ileum was identified on arterial phase CT (A) with delayed enhancement on venous phase. This three-dimensional angiographic reconstruction reveals a vascular tuft with a long draining vein in the right lower quadrant area (B). Arrow, arteriovenous malformation.

• 

  Fig. 3 Finding of enteroclysis revealed a segmental, nodular, and uneven elevated lesion with a length of 10 cm in the terminal ileum, with no other obvious source of hemorrhage in the remaining small bowel (arrow).

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  Fig. 4 Photograph of ileocecectomy specimen showing a nodular dilated vascular lesion at luminal surfaces in the terminal ileum (arrow).

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  Fig. 5 Photomicrograph of a pathological specimen revealing dilated thick-walled vascular structures involving all layers of the bowel wall (hematoxylin-eosin, original magnification×12.5). Arrowheads, arteriovenous malformation.

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