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GE-Portuguese Journal of Gastroenterology
Print version ISSN 2341-4545
GE Port J Gastroenterol vol.26 no.5 Lisboa Oct. 2019
https://doi.org/10.1159/000494846
IMAGES IN GASTROENTEROLOGY AND HEPATOLOGY
Giant Tree Branch Arteriovenous Malformation of the Hepatic Angle
Malformação arteriovenosa em ramo de árvore do ângulo hepático
Mafalda Sousa, Ana Ponte, Sónia Fernandes
Gastrenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
* Corresponding author.
Keywords: Arteriovenous malformation, Colon, Colonoscopy
Palavras-Chave: Malformação arteriovenosa, Cólon, Colonoscopia
A 65-year-old woman was referred for colonoscopy due to altered bowel habits without anemia or gastrointestinal blood loss. Colonoscopy revealed a giant tree branch arteriovenous malformation with hemi-circumferential involvement of the hepatic angle (Fig. 1) and a bluish protrusion of the colonic wall (Fig. 2), suggestive of a vascular structure. Computed tomography and angiography were performed revealing an arteriovenous malformation measuring 14 mm (Fig. 3), originating from a branch of the right colonic artery. The malformation had a preferential venous component due to the predominance of late vascularization, and, therefore, it was not embolized. The patient maintains vigilance without gastrointestinal blood loss or anemia.
Arteriovenous malformations are aberrant vessels with thickened and hypertrophic walls. Although they are found mainly in the extremities, they may occur anywhere in the vascular tree [1]. In the colon, they are rare, may be small, and may resemble angiectasias, or they may involve a long segment of the bowel wall [2, 3].
In this paper, we present an asymptomatic giant tree branch arteriovenous malformation with hemi-circumferential involvement of the hepatic angle.
References
1 Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, et al. Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: two case reports and a literature review. Saudi J Gastroenterol. 2017 Jan-Feb;23(1):6770. [ Links ]
2 Sun Z, Adam MA, Mantyh CR. Colonic Arteriovenous Malformations. In: Pryor A, Pappas T, Branch M, editors. Gastrointestinal Bleeding. Cham: Springer; 2016. https://doi.org/10.1007/978-3-319-40646-6_14 [ Links ]
3 Meyer CT, Troncale FJ, Galloway S, Sheahan DG. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine (Baltimore). 1981 Jan;60(1):3648. [ Links ]
Statement of Ethics
Informed patient consent was obtained for publication of the case details.
Disclosure Statement
The authors received no financial support and have no competing interests.
* Corresponding author.
Mafalda Sousa
Gastrenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho
Rua Conceição Fernandes, s/n
PT4434-502 Vila Nova de Gaia (Portugal)
E-Mail mafalda_m_p_sousa@hotmail.com
Received: October 14, 2018; Accepted after revision: October 19, 2018