Type of publication:Conference abstract
Author(s):*Jones G.A.R.; *Hinwood D.; *McCloud J.; McCafferty I.
Citation:Colorectal Disease; Sep 2021; vol. 23 ; p. 126
Abstract:Small bowel arteriovenous malformation (AVM) is uncommon with an incidence of approximately 1:100,000. Nevertheless cases causing severe anaemia may necessitate surgery posing the dilemma for the surgeon at operation of exactly which portion of small bowel to resect. We present a case of a rare mid small bowel AVM definitively managed with highly selective mesenteric angiography and embolisation with Onyx immediately prior to surgical resection. Onyx is an injectable embolic fluid for which the main application is in the treatment of brain AVMs. To the authors' knowledge this is the first reported case of its use in small bowel AVM. Being black in colour Onyx demonstrates the location and extent of the abnormal bowel segment allowing preservation of normal small bowel. Secondly it reduces the blood flow in the abnormal segment reducing bleeding. A 24 year old man was referred with severe recurrent iron deficiency anaemia since childhood having required multiple blood transfusions and iron infusions. His diagnosis of mid small bowel AVM was made by capsule endoscopy showing small bowel varices and confirmed with CT angiography. On the day of the procedure at angiography the SMA was catheterised and selective injections confirmed the mid small bowel AVM. Micro catheters were then used to selectively enter jejunal branches and embolisation was performed with Onyx and micro-coils. The patient was transferred to theatre for laparotomy. Small bowel resection was performed transfixing all pedicles and stapled anastamosis. Four months post-operatively the patient has had no further problems with anaemia.
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