Ileal arteriovenous malformation in an adolescent: A case report

Abstract

Introduction

Arteriovenous malformations (AVM) of the gastrointestinal tract are rare congenital vascular anomalies, particularly in the pediatric population.

Case presentation

A previously healthy 16-year-old male, with a past medical history of mild intermittent asthma and iron deficiency anemia presented with acute non-bilious vomiting and periumbilical abdominal pain without peritonitis. Initial abdominal radiography showed several grouped, round calcifications in the left lower quadrant. Computed tomography (CT) revealed a thickened loop of small bowel with calcifications. Focused ultrasonography demonstrated thickened loops of bowel that contained color Doppler flow, and several shadowing echogenic foci. His symptoms resolved spontaneously, and he was discharged home with a plan for potential elective surgery. He presented to the hospital 11 days later with abdominal pain and was taken to the operating room for an exploratory laparoscopy. We found a 13-cm vascular lesion in the ileum. We made a small periumbilical incision, eviscerated and resected the ileum containing the vascular lesion and did an end-to-end anastomosis. The postoperative course was uneventful, and he was discharged home on postoperative day two. The histology was consistent with an AVM, with dilated thick and thin-walled vessels and scattered calcifications.

Conclusion

AVM of the small bowel should be included in the differential diagnosis of children who develop abdominal pain and have localized abdominal calcifications and localized bowel wall thickening on imaging studies.