Small intestine polypoid arteriovenous malformation: a stepwise approach to diagnosis in a paediatric case

Area of Science:

• Gastroenterology
• Pediatric Endoscopy
• Vascular Malformations

Background:

• Obscure gastrointestinal bleeding (OGIB) presents diagnostic challenges, particularly in pediatric patients.
• Arteriovenous malformations (AVMs) are rare but significant causes of gastrointestinal hemorrhage.
• A history of prior unexplained bleeding necessitates thorough investigation for underlying lesions.

Observation:

• A pediatric patient presented with acute gastrointestinal hemorrhage.
• The patient had a history of obscure gastrointestinal bleeding (OGIB) eight years prior.
• A polypoid arteriovenous malformation (AVM) in the small intestine was identified as the source of bleeding.

Findings:

• Video capsule endoscopy (VCE) enabled initial diagnosis of the small intestine AVM.
• Single-balloon push enteroscopy confirmed the AVM diagnosis.
• The AVM was successfully localized via submucosal tattoo for surgical resection and duodenoduodenostomy.

Implications:

• This case highlights the utility of a stepwise diagnostic approach using advanced endoscopic technologies for pediatric OGIB.
• Video capsule endoscopy (VCE) and push enteroscopy are crucial tools for identifying small bowel lesions.
• Effective management of pediatric AVMs causing GI bleeding can be achieved with modern diagnostic and therapeutic endoscopy.