TY - JOUR A2 - Kotzalidis, Georgios D. AU - Hirakawa, Masahiro AU - Ishizuka, Rie AU - Sato, Masanori AU - Hayasaka, Naotaka AU - Ohnuma, Hiroyuki AU - Murase, Kazuyuki AU - Takada, Kohichi AU - Ito, Tatsuya AU - Nobuoka, Takayuki AU - Miyanishi, Koji AU - Kobune, Masayoshi AU - Takemasa, Ichiro AU - Kato, Junji PY - 2019 DA - 2019/12/11 TI - Management of Multiple Arteriovenous Malformations of the Small Bowel SP - 2046857 VL - 2019 AB - A 62-year-old Japanese female was referred to our hospital with gastrointestinal bleeding. Although small-bowel bleeding was suspected, no bleeding source was identified by enhanced computed tomography (CT), video capsule endoscopy (VCE), and double-balloon enteroscopy (DBE). Five years later, the patient had recurrent intermittent bloody stools with a significant decrease in hemoglobin levels. Although no active bleeding was observed on antegrade DBE, we detected a pulsatile submucosal uplift accompanied by a small red patch on the top of the uplift in the jejunum. Arteriovenous malformation (AVM) was suspected as the cause of small-bowel bleeding. Multiple-phase CT showed a number of small vascular ectasias during the arterial phase in the jejunum, and we confirmed the presence of multiple AVMs in the jejunum by selective angiography. To identify the location of the lesions and determine the minimal surgical margins, we performed intraoperative selective angiography with indocyanine green (ICG) injection. This technique allowed us to clearly observe the region and perform segmental small-bowel resection with minimal surgical margin. The patient reported that she has had no gastrointestinal bleeding at the two years follow-up visit. SN - 1687-9627 UR - https://doi.org/10.1155/2019/2046857 DO - 10.1155/2019/2046857 JF - Case Reports in Medicine PB - Hindawi KW - ER -