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Wagner T, Mustafov O, Hummels M, Grabenkamp A, Thomas MN, Schiffmann LM, Bruns CJ, Stippel DL, Wahba R. Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques: A case report. World J Clin Cases 2023; 11:5530-5537. [PMID: 37637700 PMCID: PMC10450370 DOI: 10.12998/wjcc.v11.i23.5530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/28/2023] [Accepted: 07/18/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND This case report demonstrates the simultaneous development of a gastrointestinal stromal tumour (GIST) with arteriovenous malformations (AVMs) within the jejunal mesentery. A 74-year-old male presented to the department of surgery at our institution with a one-month history of abdominal pain. Contrast-enhanced computed tomography revealed an AVM. During exploratory laparotomy, hyperspectral imaging (HSI) and indocyanine green (ICG) fluorescence were used to evaluate the extent of the tumour and determine the resection margins. Intraoperative imaging confirmed AVM, while histopathological evaluation showed an epithelioid, partially spindle cell GIST. CASE SUMMARY This is the first case reporting the use of HSI and ICG to image GIST intermingled with an AVM. The resection margins were planned using intraoperative analysis of additional optical data. Image-guided surgery enhances the clinician's knowledge of tissue composition and facilitates tissue differentiation. CONCLUSION Since image-guided surgery is safe, this procedure should increase in popularity among the next generation of surgeons as it is associated with better postoperative outcomes.
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Affiliation(s)
- Tristan Wagner
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Onur Mustafov
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Marielle Hummels
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Anders Grabenkamp
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Michael N Thomas
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Lars Mortimer Schiffmann
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Christiane J Bruns
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Dirk L Stippel
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
| | - Roger Wahba
- Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
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Tohma T, Okabe Y, Ushio M, Saito M. Arteriovenous malformation of small intestine successfully treated by double-balloon enteroscopy and laparoscope-assisted surgery. J Surg Case Rep 2022; 2022:rjac606. [PMID: 36601092 PMCID: PMC9803965 DOI: 10.1093/jscr/rjac606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
Arteriovenous malformation (AVM) of the small bowel is a rare disease and can be sometimes difficult to treat due to the diagnostic difficulty. We herein report a case of small intestinal bleeding of AVM successfully treated with double-balloon enteroscopy (DBE) and laparoscope-assisted resection. A 44-year-old man complained of hematochezia and visited the previous doctor. He underwent gastroscopy and colonoscopy, but no bleeding site was detected. However, he rebled 2 days later and became hypotensive. Abdominal computed tomography revealed a hypervascular nodule in the jejunum. He was transferred to our institution for further treatment. DBE was performed and revealed a small pulsatile lesion with a tiny mucosal break. We then injected a marking tattoo. Two days later, he underwent an operation. We were able to easily locate the tattooed lesion laparoscopically and performed jejunal partial resection. His postoperative course was uneventful. DBE enabled a precise diagnosis and minimal invasive surgery.
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Affiliation(s)
- Takayuki Tohma
- Correspondence address. E-mail: ; Tel: +81-43-279-2211; Fax: +81-43-279-0193
| | - Yasuyuki Okabe
- Life Support and Emergency Center, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Masaya Ushio
- Department of Acute Care Surgery, Chiba Emergency Medical Center, Chiba, Japan
| | - Masaya Saito
- Department of Gastroenterology and Hepatology, Seikei-Kai Chiba Medical Center, Chiba, Japan
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A case of arteriovenous malformation in the inferior mesenteric artery region resected surgically under intraoperative indocyanine green fluorescence imaging. Int J Surg Case Rep 2022; 92:106831. [PMID: 35176584 PMCID: PMC8857500 DOI: 10.1016/j.ijscr.2022.106831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
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Kurata Y, Hayano K, Matsusaka K, Mamiya H, Uesato M, Murakami K, Kano M, Toyozumi T, Matsumoto Y, Suito H, Isozaki T, Ohira G, Hayashi H, Matsubara H. A case report of duodenal arteriovenous malformation: usefulness of intraoperative indocyanine green angiography for precise identification of the lesion. Surg Case Rep 2022; 8:4. [PMID: 34982282 PMCID: PMC8727664 DOI: 10.1186/s40792-021-01356-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Arteriovenous malformation (AVM) of the gastrointestinal (GI) tract can cause bleeding. The treatment choice for GI tract AVM is surgical resection of the involved bowel segment with complete resection of the nidus. The AVM formed in the duodenum or pancreatic head could also cause gastrointestinal bleeding, and there are several reports of pancreaticoduodenectomy as its treatment. However, if the area of AVM can be accurately identified during surgery, it may be possible to completely resect the AVM while preserving the organ. We report a case of duodenal AVM in a patient successfully treated with a subtotal stomach-preserving duodenal bulb resection using intraoperative indocyanine green (ICG) angiography technique. Case presentation An 18-year-old man was diagnosed with duodenal AVM after several examinations for anemia and was referred to our hospital for further treatment. Preoperative imaging studies showed that the inflow vessels of this duodenal AVM were the inferior pyloric artery and the superior duodenal artery, and the AVM was localized to the duodenal bulb. Thereafter, stomach-preserving duodenal bulb resection preceded by ligation of the inflow vessels was performed. During the surgery, ICG angiography clearly demonstrated the area, where the nidus was distributed, and a duodenal bulb resection with complete resection of the AVM was successfully performed. There was no recurrence at the 6-month follow-up. Conclusions Intraoperative ICG angiography was a useful procedure for precise identification of the AVM of the GI tract.
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Affiliation(s)
- Yoshihiro Kurata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan.
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Keisuke Matsusaka
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Hisashi Mamiya
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Masayuki Kano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Hiroshi Suito
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Tetsuro Isozaki
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
| | - Hideki Hayashi
- Center for Frontier Medical Engineering, Chiba University, Chiba City, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8677, Japan
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Iraha A, Irei Y, Kinjo T, Oishi Y, Ohira T, Kinjo T, Hokama A, Kosuge N, Wada N, Takatsuki M, Fujita J. Jejunal Arteriovenous Malformation Detected by Video Capsule Endoscopy. Chonnam Med J 2022; 58:75-76. [PMID: 35677950 PMCID: PMC9163605 DOI: 10.4068/cmj.2022.58.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Atsushi Iraha
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yasue Irei
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tatsuya Kinjo
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuiko Oishi
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tetsuya Ohira
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tetsu Kinjo
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Akira Hokama
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Noritake Kosuge
- Department of Pathology, Seirei Yokohama Hospital, Kanagawa, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mitsuhisa Takatsuki
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Kudo W, Kouchi K, Takenouchi A, Matsuoka A, Yabe K, Nakazawa T, Hasegawa A. Recurrent massive bleeding from a small intestinal arteriovenous malformation after surgery for biliary atresia in an infant: a case report and literature review. Surg Case Rep 2021; 7:204. [PMID: 34495444 PMCID: PMC8426411 DOI: 10.1186/s40792-021-01288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Small intestinal arteriovenous malformation (AVM) can cause bleeding. Most small intestinal AVMs occur during adulthood, rarely in infancy. We report a case of an infant with hemorrhage due to small intestinal AVM early and recurrently after Kasai portoenterostomy (PE) for biliary atresia (BA). CASE PRESENTATION A 51-day-old male infant was admitted to our institution for obstructive jaundice. Laparotomic cholangiography revealed BA (IIIb1μ), and Kasai PE was performed at 60 days of age. On postoperative day 17, he developed massive melena and severe anemia. Contrast-enhanced computed tomography (CT) revealed that the jejunum around the PE site was strongly enhanced with enhancing nodules in the arterial phase, and a wide area of the Roux limb wall was slightly enhanced in the venous phase. As melena continued, emergency laparotomy was performed. There were no abnormal macroscopic findings at the PE site except for a clot in the Roux limb 5 cm away from the PE site, and the Roux limb was resected 5 cm. On further investigation, a red spot was detected on the jejunal serosa 30 cm away from the Roux-en-Y anastomosis site. PE and wedge resection for the red spot were performed. Histopathologically, both specimens indicated AVM. He was jaundice-free 65 days after the first surgery. However, at 7 months of age, he developed massive melena again. Contrast-enhanced CT and upper gastrointestinal endoscopy revealed no bleeding lesions. Hemorrhagic scintigraphy showed a slight accumulation at the hepatic hilum prompting an emergency surgery. Intraoperative endoscopy detected a bleeding lesion at the PE site, and the Roux limb was resected (approximately 6 cm). Intraoperative frozen section analysis of the stump of the resected jejunum revealed no abnormal vessels. PE was performed, and permanent section analysis revealed an AVM in the resected jejunum. The postoperative course was uneventful without re-bleeding. CONCLUSIONS We experienced a case of recurrent massive bleeding from small intestinal AVM in an infant after surgery for BA. Intraoperative endoscopy and frozen section analysis helped identify the bleeding lesion and perform a complete resection of the small intestinal AVM, even after surgery, in the infant.
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Affiliation(s)
- Wataru Kudo
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan.
| | - Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Aki Matsuoka
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Kiyoaki Yabe
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Tadao Nakazawa
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
| | - Atsuko Hasegawa
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Ohwada-shinden, Yachiyo, Chiba, 276-8524, Japan
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