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Abstract
Arteriovenous malformation (AVM) is a lesion involving a high-flow vascular malformation, which is one of the causes of massive gastrointestinal bleeding. In the pediatric population, AVM is quite rare in the gastrointestinal tract, and the most common primary site is the colon. A small bowel is a rare primary site of AVM, and only 1 case has been reported in Korea. Here, we report on a case of AVM found in the distal ileum of a 14-year-old girl who complained about recurrent lower abdominal pain only without a gastrointestinal hemorrhage. In the previous research literature, a small bowel AVM can be diagnosed through detecting the existence of an enhancing nidus of the intestinal wall at the arterial phase, accompanied by an early draining vein as it appeared on a dynamic contrast-enhanced abdominal computed tomography. In our case, the pathologically confirmed AVM of the distal ileum showed a dot-like enhancement within the thick low-attenuating submucosal layer of the terminal ileum.
Figures and Tables
Fig. 1
Radiological and pathological findings of arteriovenous malformation in distal ileum in a 14-year-old girl with recurrent abdominal pain.
A. B. Postcontrast CT axial (A) and coronal (B) images of small bowel AVM show the segmental low-attenuating wall thickening of the terminal ileum with internal multiple enhancing foci (arrows).
C. Abdominal ultrasound image shows a thick hypoechoic submucosal layer (the distance between lines) of the terminal ileum and multiple internal echogenic foci (arrowhead).
D. Gross photograph of the ileocecectomy specimen shows multiple depressed mucosal petechiae (arrowheads) due to the mucosal erosion, produced by the hemorrhage from the AVM.
E. Photomicrograph (hematoxylin and eosin stain × 100) shows submucosal abnormal vessels with various lumen sizes and thickness filled with blood (arrowheads).
F. Photomicrograph (Verhoeff–van Gieson stain, × 200) shows the presence of elastic fibers in the intima of the arterialized vein (arrowhead) and the disruption of elastic fibers in the intima and external lamina in the arteriole (arrow).
AVM = arteriovenous malformation
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