Abstract
A 57-year-old man was admitted to our hospital because of frequent hematochezia. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. Abdominal contrast-enhanced computed tomography showed a rectal arteriovenous malformation (AVM) on the right side wall of the lower rectum. The feeder was the superior rectal artery, with early venous return. Embolization of the draining vein and feeding artery of the AVM with N-butyl-2-cyanoacrylate under balloon occlusion was planned. Angiography of the superior rectal artery showed the nidus in the rectum with early venous return of contrast material. The portal vein was punctured percutaneously under ultrasound guidance, and a balloon catheter advanced to the distal part of the superior rectal vein. Venography under balloon occlusion showed the outflow vein and nidus. Transvenous and transarterial nidus embolization with N-butyl-2-cyanoacrylate under balloon occlusion was then performed. Since the embolization, there have been no further episodes of bleeding. There is no established treatment for AVMs. Successful treatment requires targeting and eradication of the nidus. We successfully performed embolization therapy for a rectal AVM via a retrograde transvenous approach. This technique may be suitable for completely eradicating the nidus without the risk of embolism.
Highlights
Intestinal arteriovenous malformations (AVMs) are a common cause of lower gastrointestinal bleeding [1, 2]
An AVM is an abnormal connection between arteries and veins that bypasses the capillary system
AVMs in the gastrointestinal tract are characterized by diffuse vasodilation in all layers from the submucosal to the serosal layer and are composed of an inflow artery
Summary
Intestinal arteriovenous malformations (AVMs) are a common cause of lower gastrointestinal bleeding [1, 2]. AVMs have generally been treated surgically, either by ligation of the afferent arteries or by attempts at excision. Less invasive treatments such as endoscopic treatment and transcatheter arterial embolization (TAE) have been reported; additional treatment may be required for recurrence after treatment with these modalities [3, 4]. A 57-year-old man was admitted to our hospital because of painless hematochezia after defecation. He had facial and conjunctival pallor consistent with anemia. An abdominal contrast-enhanced computed tomography (CECT) showed a collection of dilated blood vessels on the right side wall of the lower rectum. The feeder was the superior rectal artery (SRA), with early venous return
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