Upper gastrointestinal bleeding due to duodenal arteriovenous malformation. About a rare case

The gastrointestinal bleeding (GB) is one of the most common emergencies nowadays. Vascular anomalies have been accounted for 5% of the GB. Among them is arteriovenous malformation, a rare congenital anomaly, which is characterized by direct connections between the venous and arterial systems in the absence of a capillary bed.

We present a case of a 35-year-old male, with a history of a HIV infection and an upper GB due to duodenal ulcers (Forrest III). The patient is admitted again with a new episode of GB. A gastroscopy is performed were 2 duodenal ulcers (Forrest III) were seen. During admission, he suffers 2 more episodes of GB with hemodynamic instability, requiring intensive care treatment. It was decided to perform an abdominal CT scan which revealed an arteriovenous malformation with proliferation of periduodenal vessels, dependent on the superior mesenteric artery. Finally, through interventional vascular radiology, coils were placed in the gastroduodenal artery and the main duodenal branch of the superior mesenteric artery. A marked decrease in the proliferation of arterial branches is observed with a subsequent imaging test [1] [2].

Duodenal arteriovenous malformation is a rare cause of upper GB. Its location influences the therapeutic alternative, in this case embolization was high risk due to the possibility of migration to the portal vein and other large vessels. That’s why coil placement was finally chosen. If this therapeutic procedure had not been effective, surgical intervention would have been necessary, specifically due to its location, a cephalic pancreaticoduodenectomy

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Marcelin C, Park AW, Gilbert P, Bouchard L, Therasse E, Perreault P, Giroux MF, Soulez G.. Management of Pancreatico-duodenal arterio-venous malformation. CVIR Endovasc 2022; 5 (1): 2
• 2 Kitazono M, Fujita M, Katsue K, Ikeda N, Oyama T, Eguchi M, Kamimura G, Sato R, Uchiyama S, Toyosaki R, Suenaga T.. A case of emergency pancreatoduodenectomy for bleeding from the duodenal mucosa due to arteriovenous malformation of the pancreatic head. Clin Case Rep 2021; 9 (9): e04824 PMID: 34584707; PMCID: PMC8455972