Jejunoileal arteriovenous malformation: localization for resection by segmental bowel staining techniques

Area of Science:

• Gastroenterology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Submucosal arteriovenous malformations (AVMs) in the jejunum and ileum cause chronic gastrointestinal bleeding and anemia.
• These lesions are difficult to locate during surgery due to a lack of physical signs, despite being identifiable via selective arteriography preoperatively.

Observation:

• A patient with a proximal jejunal AVM underwent successful intraoperative identification via subselective arterial injection of Indigo Carmine.
• The targeted jejunal segment remained stained for 45 minutes, facilitating accurate resection.

Findings:

• Indigo Carmine injection into the jejunal artery immediately prior to surgery provides reliable intraoperative visualization of AVMs.
• Staining duration (35-55 minutes) in related colectomy cases suggests a consistent window for accurate localization.
• Canine studies with colloidal carbon demonstrated prolonged staining (5 days) without bowel injury, indicating potential for earlier diagnostic injection.

Implications:

• This technique offers a safe and convenient method for intraoperative AVM identification, potentially reducing surgical complications.
• The findings suggest that staining procedures could be integrated into the initial diagnostic workup, improving diagnostic accuracy and surgical planning.
• Further research into pre-diagnostic staining could revolutionize the management of obscure gastrointestinal bleeding sources.