Transvaginal flexible endoscopy for bleeding arteriovenous malformation hemostasis near a vesico-rectovaginal fistula

Q3 Medicine

VideoGIE Pub Date : 2025-02-21 DOI:10.1016/j.vgie.2025.02.004

Reona Tsukii MD , Kazuya Inoki MD, MPH, PhD , Kenichi Konda MD, PhD , Atsushi Katagiri MD, PhD , Fuyuhiko Yamamura MD, PhD , Takashi Mimura MD, PhD , Hitoshi Yoshida MD, PhD

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引用次数: 0

Abstract

Background and Aims

Flexible GI endoscopy has been applied in the field of gynecology. GI endoscopy is useful in diagnosing uterine cervical cancers, because high-resolution imaging using magnification enables targeted biopsies. Moreover, hemostasis for uterine cancer using GI endoscopy and hemostatic forceps, as well as the local treatment of vaginal intraepithelial neoplasia, have been achieved.

Methods

In the present case, hemostasis for arteriovenous malformation using argon plasma coagulation was attained with transvaginal endoscopy.

Results

An 85-year-old female patient presented to our hospital for admission with intermittent rectal and genital bleeding. She had previously undergone concurrent chemoradiotherapy for cancer of the uterine body, at 45 years of age. Furthermore, she had undergone a colostomy and urostomy for a vesico-rectovaginal fistula, in her 70s. The source of the bleeding could not be identified by contrast-enhanced abdominal computed tomography, cystoscopy, vaginal examination, or rectal endoscopy. Spontaneous hemostasis was achieved; nevertheless, she was readmitted to our hospital because of a recurrence of symptoms and progressively worsening anemia. Vaginoscopy revealed blood in the vagina; however, the source of bleeding was not detected, particularly by subsequent rectal endoscopy. An oozing from arteriovenous malformation near the vesico-rectovaginal fistula was identified by transvaginal endoscopy. Hemostasis was achieved, using argon plasma coagulation. No recurrence of bleeding was observed after endoscopic hemostasis. The absence of symptomatic recurrence was confirmed at the 1-month follow-up, after discharge.

Conclusions

In this case, transvaginal endoscopy revealed the source of bleeding that was in the blind spot, during rectal endoscopy. This case highlighted that further applications using flexible GI endoscopy in the field of gynecology should be investigated.

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经阴道柔性内窥镜治疗膀胱直肠阴道瘘附近动静脉畸形出血止血

背景与目的柔性胃肠道内镜在妇科领域的应用越来越广泛。胃肠道内窥镜检查在诊断子宫癌中是有用的，因为使用放大的高分辨率成像可以进行靶向活检。此外，应用胃肠道内镜和止血钳止血子宫癌，以及阴道上皮内瘤变的局部治疗已经实现。方法本病例采用经阴道内窥镜下氩离子凝固术止血动静脉畸形。结果1例85岁女性患者因间歇性直肠及生殖器出血来我院就诊。她在45岁时曾因子宫体癌接受同步放化疗。此外，她在70多岁时接受了结肠造口术和膀胱直肠阴道瘘的泌尿造口术。出血的来源不能通过增强腹部计算机断层扫描、膀胱镜检查、阴道检查或直肠内窥镜检查确定。自动止血；然而，由于症状复发和贫血逐渐恶化，她再次入院。阴道镜检查发现阴道内有血；然而，出血的来源没有被发现，特别是随后的直肠内窥镜检查。经阴道内窥镜检查发现膀胱直肠阴道瘘附近的动静脉畸形渗出。采用氩离子凝固术止血。内镜下止血后无出血复发。出院后1个月随访无症状复发。结论本病例在直肠内镜检查时，经阴道内镜检查发现出血的源头位于盲区。本病例强调，应进一步研究柔性胃肠道内镜在妇科领域的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.