Volume 29, Issue 155, January 2025

Lower gastrointestinal hemorrhage in a case of mesenteric arteriovenous malformation with fistula: A case report from Vietnam

Duc M Tran¹, Duc K Ho², Dai T Nguyen¹, Khanh G Cheng^1,3, Phuoc T Bui^3♦, Nguyen Ly⁴

¹Deparment of Emergency, Binh Dan Hospital, Ho Chi Minh City, Vietnam
²Deparment of Cardio and Vascular Surgery, Binh Dan Hospital, Ho Chi Minh City, Vietnam
³Department of General Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
⁴Department of General Surgery, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam

^♦Corresponding Author
Department of General Surgery, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam

ABSTRACT

Background: Gastrointestinal vascular malformations are rare and challenging-todiagnose causes of gastrointestinal bleeding, accounting for 5% of non-variceal upper gastrointestinal hemorrhages. We describe a clinical case of a young female patient with superior mesenteric arteriovenous malformation accompanied by a fistula leading to severe gastrointestinal bleeding. Additionally, we review the literature on this condition and provide information about diagnostic tools and applicable treatment methods. Case Presentation: A 28- year-old female patient presented with a four-month history of hematochezia. She arrived at the emergency department of Binh Dan Hospital in a state of severe anemia. Esophagogastroduodenoscopy up to the first part of the duodenum and colonoscopy up to the cecum did not reveal signs of bleeding. A CT angiography of the abdomen identified a superior mesenteric arteriovenous malformation with active bleeding into the small intestine, suggesting the presence of a fistula from the malformed vessels. The surgical team performed an emergency laparotomy and resected a segment of the small intestine along with the mesentery containing the malformed vessels to control the bleeding source. Conclusion: This clinical case describes a rare condition of mesenteric arteriovenous malformation with a fistula causing severe gastrointestinal hemorrhage. It emphasizes the key clinical features, the critical role of CT angiography and endoscopy in achieving an accurate diagnosis, as well as appropriate surgical treatment methods.

Keywords: Mesenteric arteriovenous malformation, Arteriovenous fistula, Gastrointestinal hemorrhage

Medical Science, 2025, 29, e1ms3500

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DOI: https://doi.org/10.54905/disssi.v29i155.e1ms3500

Published: 09 January 2025