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Abstract
A 51-year-old man visited the tertiary-care hospital with a 2-week history of dizziness and dyspnea on exertion. The initial hemoglobin level was 5.8 g/dL, without any history of hematochezia or melena. The esophagogastroduodenoscopy (EGD) was normal. During colonoscopic preparation, the patient experienced hematochezia and became hypotensive. On angiography, no extravasation of contrast media was observed. A CT scan with angiography showed a small high-density area in the jejunal lumen, suggesting extravasation of the contrast media. Capsule endoscopy was performed, and oozing bleeding was suspected in the proximal to mid jejunum. The patient was referred to our hospital. Repeated EGD and CT enterography did not reveal any significant bleeding. An antegrade double balloon endoscopy was performed, and an approximately 2-cm-sized submucosal tumor with ulceration and a non-bleeding exposed vessel was observed in the mid jejunum. The presumed diagnosis was jejunal gastrointestinal stromal tumor. The mass was surgically resected, and the final histopathological diagnosis was arteriovenous malformation.
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Fig. 1.
Computed tomography scan with angiography performed at the referral hospital. (A) Axial scan revealed a small high-density area in the jejunal lumen (arrow). (B) A coronal view reconstruction revealed a small high-density area in the jejunal lumen (arrow).
Fig. 2.
During double balloon endoscopy, an approximately 2-cm-sized submucosal mass with an ulcer and a non-bleeding exposed vessel was observed in the mid jejunum. The presumed diagnosis was gastrointestinal stromal tumor with bleeding.
Fig. 3.
Surgical specimens and pathologic findings. (A, B) The surgical specimen showed a well-demarcated protruding mass in the jejunum, which measured 1.8×1.0×1.0 cm. The cut surface was grayish brown colored with hemorrhagic change. (C-F) Histologic examination showed tangles of abnormal vessels in the submucosa. These various-sized vessels have characteristics of arteries and veins without intervening capillaries. The surface mucosa was severely eroded, involving the large vessel (H&E; C: ×40, D: ×12.5, E: ×40, F: ×100).
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