Intraoperative endoscopy as an adjunct to surgical ligation of multiple arteriovenous malformations

We present a case report of a 69-year-old man with multiple medical problems who presented to the Veterans Hospital in Tucson, Arizona, with recurrent upper gastrointestinal bleeding following multiple upper endoscopic attempts at chemical injection and thermal coagulation of several vascular malformations of the duodenum. Intraoperative endoscopy was employed to identify the location of three small mucosal lesions. By employing transmural endoscopic illumination and direct endoscopic visualization we identified all arteriovenous malformations and then ligated them with silk ligatures from the bowel wall exterior during surgical exploration, avoiding duodenotomy and duodenectomy. The patient has had an uneventful recovery with no evidence of recurrent bleeding at a 1-year follow-up.