S2987 Arteriovenous Malformation of Stomach: A Rare Case of Symptomatic Non-Bleeding Gastric Subepithelial Lesion

Abstract

INTRODUCTION: Gastric arteriovenous malformations (AVM) are rarely been reported. They are uncommon cause of upper gastrointestinal bleeding and abdominal pain. Here we report an unusual case of a middle-aged female who presented to us with intermittent epigastric discomfort and was diagnosed as a case of gastric AVM also mimicking dieulafoy lesion. CASE DESCRIPTION/METHODS: A 50-year-old female with a past medical history of hypertension, hyperlipidaemia, GERD, and depression was admitted to the hospital with intermittent epigastric discomfort, bloating, and decreased appetite for 4 months. There was also a history of 10 lbs of weight loss. There was no history of dysphagia or odynophagia. Physical examination was within normal limits and laboratory investigations were unremarkable. CT abdomen was performed due to concerns of weight loss which revealed a 1.5 cm lesion in the gastric fundus. The patient underwent an EGD which showed 1.5 cm subepithelial lesion with smooth overlying surface present in the gastric fundus with no ulcerations. Differential diagnoses included GIST, leiomyoma, and carcinoid. Endoscopic ultrasound was performed which showed the presence of 11.8 mm × 10.1 mm hypoechoic lesion which appears to be arising from the submucosal layer with mild internal vascularity. The muscularis propria layer appeared intact. A complete endoscopic mucosal resection was performed. Pathology was sent and showed benign gastric mucosa with proliferation of blood vessels in the submucosa. Although the vessels were prominent, but they were not large or tortuous as seen in Dieulafoy's lesion. Patient was later discharged on oral proton pump inhibitor for 4 weeks. On follow up clinic visit she remained asymptomatic and improved clinically. DISCUSSION: Gastric AVMs represent 1.4% of all intestinal AVMs. It is a congenital lesion with direct connection between its arterial and venous component. Gastric AVMs are diagnosed on endoscopy and treatment mostly involves endoscopic removal or surgery. The gastric AVM in our case mimicked a dieulafoy lesion. However the pathology confirmed it to be an gastric AVM.Figure 1.: EGD showed a 1.5 cm subepithelial lesion with smooth overlying surface present in the gastric fundus with no ulcerations.Figure 2.: EUS showing a 11.8 mm × 10.1 mm hypoechoic sub-epithelial lesion which appears to be arising from submucosa with mild internal vascularity.Figure 3.: Histopathology showed benign gastric mucosa with proliferation of blood vessels in the submucosa. Although the vessels are prominent, they are not large or tortuous as seen in Dieulafoy's lesion.