Asian Journal of Case Reports in Surgery

Arteriovenous Malformation of Rectum causing Lower Gastro Intestinal Bleed Managed with Trans-Catheter Arterial Embolisation – A Case Report

Muvva Sri Harsha *

Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals, Greams Road, Chennai, India.

Prasanna Kumar Reddy

Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals, Greams Road, Chennai, India.

M. Balika

Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals, Greams Road, Chennai, India.

Vijay N.

Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals, Greams Road, Chennai, India.

Ravi Kumar R.

Department of Interventional Radiology, Apollo Hospitals, Greams Road, Chennai, India.

*Author to whom correspondence should be addressed.

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Abstract

Gastrointestinal arterio-venous malformations are uncommon causes of lower GI bleeding. Rectal AVMs are even rarer, and a high index of suspicion is needed to correctly diagnose them. There is no standardized treatment option for rectal AVMs. The choice of treatment has to be individualized, considering the overall performance and clinical status of the patient. Treatment options range from minimally invasive procedures like embolization to resection procedures such as anterior resection, ultra-low anterior resection, or abdominoperineal resection. Here, we present a case report of a 55 year old male who presented to us with lower GI bleed and after evaluation was diagnosed to have large rectal AVM. He underwent trans catheter arterial embolization with Poly vinyl alcohol particles and Coils. He had good post-operative recovery and remained symptom free.

Keywords: Arteriovenous malformation, coil embolization, lower GI bleed, hemangioma, colorectal hemangioma, trans-arterial embolization

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References

Ishikawa S, Mukai S, Hirata Y, Kohata A, Kai A, Namba Y, Okimoto S, Fujisaki S, Fukuda S, Takahashi M, Fukuda T. Rectal arteriovenous malformation treated by transcatheter arterial embolization. Case Reports in Gastroenterology. 2020 May 7;14(1):7-14.

Trieu DT, Ho AH, Van Le Q. Colorectal Arteriovenous Malformations causing Prolonged Bleeding were Managed Successfully by Laparoscopic Low Anterior Resection with Sphincter Preservation: A Case Report. The Korean Journal of Gastroenterology. 2023 May 25;81(5):216-20.

Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH. Angiodysplasia: clinical presentation and colonoscopic diagnosis. Digestive diseases and sciences. 1984 Jun;29:481-5.

Kobayashi K. Arteriovenous malformation of the Intestine: review of 230 cases reported in Japan. Stomach and Intestine. 2000;35(6):753-62.

McAllister KA, Grogg KM, Johnson DW, et al. Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet. 1994;8:345-351.

Boley SJ, DiBiase A, Brandt LJ, Sammartano RJ. Lower intestinal bleeding in the elderly. The American Journal of Surgery. 1979 Jan 1;137(1):57-64.

Richardson JD, Max MH, Flint Jr LM, Schweisinger W, Howard M, Aust JB. Bleeding vascular malformations of the intestine. Surgery. 1978 Sep 1;84(3):430-6.

Parthasarathy M, Basu A, Omer AR. Massive per rectal bleeding in a child due to caecal arteriovenous malformation treated successfully by embolisation. Case Reports. 2013 Aug 21;2013: bcr2013010187.

Junquera F, Quiroga S, Saperas E, Pérez-Lafuente M, Videla S, Alvarez-Castells A, Miró JR, Malagelada JR. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000 Aug 1;119(2):293-9.

Mallios A, Laurian C, Houbballah R, Gigou F, Marteau V. Curative treatment of pelvic arteriovenous malformation–an alternative strategy: transvenous intra-operative embolisation. European Journal of Vascular and Endovascular Surgery. 2011 Apr 1;41(4):548-53.

Cotzias E, Rehman SF, Arsalani Zadeh R, Smith D. Conservative management of diffuse cavernous haemangioma of the sigmoid and rectum. The Annals of the Royal College of Surgeons of England. 2020 Jan;102(1):e1-3.

Seffinger MA. Our past, present, and future are in our hands. J Am Osteopath Assoc. 2014 Jan;114(1):4.

DOI:10.7556/jaoa.2014.001.

PMID: 24384967.

Saito N, Sasaki S, Shimizu T, Nozaki A, Yamatsu Y, Takahashi K, et al. Embolization with microspheres in the treatment of subcutaneous arteriovenous malformation: a case report. Sosyo. 2015 Apr;6(2):77–81.

Almadi MA, Almessabi A, Wong P, Ghali PM, Barkun A. Ectopic varices. Gastrointest Endosc. 2011 Aug;74(2):380-8.

DOI:10.1016/j.gie.2011.03.1177.

Epub 2011 May 25. PMID: 21612777.

Fishman SJ, Shamberger RC, Fox VL, Burrows PE. Endorectal pull-through abates gastrointestinal hemorrhage from colorectal venous malformations. J Pediatr Surg. 2000 Jun;35(6):982-4.

DOI: 10.1053/jpsu.2000.6947.

PMID: 10873049.

Zeng Z, Wu X, Chen J, Luo S, Hou Y, Kang L. Safety and feasibility of transanal endoscopic surgery for diffuse cavernous hemangioma of the rectum. Gastroenterol Res Pract. 2019 Jun 19; 2019:1732340.

DOI:10.1155/2019/1732340.

PMID: 31320895; PMCID: PMC6607704.

Fu ZW, Wang LX, Zhang ZY, Luo QF, Ge HY. Three-dimensional laparoscopy-assisted bowel resection for cavernous hemangioma of the rectum: Report of two cases. Asian J Endosc Surg. 2019 Jul;12(3):337-340.

DOI: 10.1111/ases.12636. Epub 2018 Aug 9. PMID: 30094939.

Fujii Y, Kobayashi K, Kimura S, Tsuji E, Miyai H, Tanaka M, Takiguchi S. Robotic surgical procedure for diffuse cavernous hemangioma of the rectum: A case report. Asian J Endosc Surg. 2020 Oct;13(4):564-568.

DOI:10.1111/ases.12783. Epub 2020 Jan 20. PMID: 31960573.