Successful laparoscopic surgery combined with selective arterial embolization for bleeding due to jejunal angiodysplasia
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CASE REPORT
Successful laparoscopic surgery combined with selective arterial embolization for bleeding due to jejunal angiodysplasia: a case report Hitoshi Hara1, Soji Ozawa1* , Kazuhito Nabeshima1 and Jun Koizumi2
Abstract Background: Angiodysplasia of the gastrointestinal tract is a rare vascular pathology that sometimes causes massive hemorrhage. Angiodysplasias are particularly difficult to find in the small intestine for anatomical reasons, often impeding their diagnosis and treatment. Lesion localization is a major challenge in cases of small bowel bleeding requiring surgical intervention. Case presentation: The present case was a 52-year-old woman who was urgently hospitalized with repeated tarry stools. Surgical intervention was chosen after conservative treatment failed to improve her condition. The source of bleeding was suspected to be a vascular lesion discovered in the small intestine during a past double-balloon endoscopy. Abdominal contrast computed tomography revealed a jejunal hemorrhage. We chose selective arterial embolization to stabilize her hemodynamics followed by surgical intervention as her treatment plan. Several embolic and contrast agents (cyanoacrylate, indigo carmine, and Lipiodol) were combined to help identify the location of the lesion during surgery. This multi-pronged approach allowed us to localize the lesion under laparoscopic guidance with high confidence and accuracy, and to excise a 6-cm segment of the small intestine. The lesion was histologically diagnosed as angiodysplasia. No re-bleeding has been observed since the operation. Conclusion: We report our experience with a case of jejunal angiodysplasia, which was localized with selective arterial embolization using an array of embolic and contrast agents, and then excised laparoscopically. Selective arterial embolization with indigo carmine dye to treat small bowel bleeding preoperatively not only makes the surgery safer by stabilizing the patient’s hemodynamics, but is also very useful for localizing the lesion intraoperatively. Keywords: Small intestinal angiodysplasia, Small bowel bleeding, Selective arterial embolization, Laparoscopic surgery, Indigo carmine Background Angiodysplasia (AGD) of the gastrointestinal tract is a rare vascular pathology that may cause massive hemorrhage. AGDs cannot always be identified due to their small size, their confinement between the mucosal surface and the lamina propria, and their tendency to bleed *Correspondence: [email protected] 1 Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan Full list of author information is available at the end of the article
intermittently. AGDs of the small intestine are particularly difficult to identify for anatomical reasons, often impeding their diagnosis and treatment [1–3]. When double-balloon enteroscopy (EBD) can identify a bleeding AGD, endoscopic hemostasis can be possible [2]. However, surgical intervention remains the most reliable treatment since rebleeding after endo
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