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Vascular malformations of the small intestine manifesting as chronic anemia: Two pediatric cases managed by single-site umbilical laparoscopic surgery

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ABSTRACT

Vascular malformation of gastrointestinal tract manifested as a chronic anemia due to obscure gastrointestinal bleeding in girls.

Vascular malformation of the small intestine in pediatric patient is uncommon finding.

Despite of limitations of diagnosis, a selective angiography and CT enterogram with angiography was helpful to diagnose.

Successfully managed two cases of vascular malformation identified at jejunum by a single-site umbilical laparoscopic surgery.

Successfully managed two cases of vascular malformation identified at jejunum by a single-site umbilical laparoscopic surgery.

No MeSH data available.


Gross appearance shows tortuous vascular branch around mesenteric surface of the jejunum.
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fig0010: Gross appearance shows tortuous vascular branch around mesenteric surface of the jejunum.

Mentions: An 8-year-old girl was admitted to the emergency room with a massive hematochezia. The patient had been followed-up for treatment of iron-deficiency anemia, 3 months prior, but presented with no gastrointestinal symptoms at the time. Initial laboratory findings showed a hemoglobin level of 4.4 g/dL and we proceeded with immediate resuscitation. Assessments for GI bleeding (Meckel’s scan, fiberoptic gastroduodenoscopy, and colonoscopy) did not reveal any specific focus of the abnormal bleeding. After stabilization, we were able to identify a focus of bleeding at the distal jejunum by selective angiography following a red blood cell (RBC) scan, which revealed tortuous and early venous return of distal jejunal branch (Fig. 1). An exploratory laparotomy through single-site umbilical laparoscopic approach was then performed, which revealed a portion of the jejunal segment involving the serosal surface to be hyperemic (Fig. 2). Approximately 15 cm of the jejunal segment including the hyperemic portion was resected. Pathology indicated an arteriovenous malformation with features of tortuous, engorged vascular structures on the serosal surface and congested mucosa along the antimesenteric border of intestine (Fig. 3).


Vascular malformations of the small intestine manifesting as chronic anemia: Two pediatric cases managed by single-site umbilical laparoscopic surgery
Gross appearance shows tortuous vascular branch around mesenteric surface of the jejunum.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304240&req=5

fig0010: Gross appearance shows tortuous vascular branch around mesenteric surface of the jejunum.
Mentions: An 8-year-old girl was admitted to the emergency room with a massive hematochezia. The patient had been followed-up for treatment of iron-deficiency anemia, 3 months prior, but presented with no gastrointestinal symptoms at the time. Initial laboratory findings showed a hemoglobin level of 4.4 g/dL and we proceeded with immediate resuscitation. Assessments for GI bleeding (Meckel’s scan, fiberoptic gastroduodenoscopy, and colonoscopy) did not reveal any specific focus of the abnormal bleeding. After stabilization, we were able to identify a focus of bleeding at the distal jejunum by selective angiography following a red blood cell (RBC) scan, which revealed tortuous and early venous return of distal jejunal branch (Fig. 1). An exploratory laparotomy through single-site umbilical laparoscopic approach was then performed, which revealed a portion of the jejunal segment involving the serosal surface to be hyperemic (Fig. 2). Approximately 15 cm of the jejunal segment including the hyperemic portion was resected. Pathology indicated an arteriovenous malformation with features of tortuous, engorged vascular structures on the serosal surface and congested mucosa along the antimesenteric border of intestine (Fig. 3).

View Article: PubMed Central - PubMed

ABSTRACT

Vascular malformation of gastrointestinal tract manifested as a chronic anemia due to obscure gastrointestinal bleeding in girls.

Vascular malformation of the small intestine in pediatric patient is uncommon finding.

Despite of limitations of diagnosis, a selective angiography and CT enterogram with angiography was helpful to diagnose.

Successfully managed two cases of vascular malformation identified at jejunum by a single-site umbilical laparoscopic surgery.

Successfully managed two cases of vascular malformation identified at jejunum by a single-site umbilical laparoscopic surgery.

No MeSH data available.