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Landolsi S, Saidi A, Ncibi S, Kallel L, Ridene I, Chebbi F. Arteriovenous gastric malformation: A challenging diagnosis. A case report. Int J Surg Case Rep 2023; 111:108880. [PMID: 37788531 PMCID: PMC10550579 DOI: 10.1016/j.ijscr.2023.108880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Gastro-intestinal bleeding etiological diagnosis could be challenging especially for rare etiologies as it was the case of our patient having an arteriovenous gastric malformation. CASE PRESENTATION A 50-years old man consulted for hematemesis. Esophagogastroduodenoscopy didn't show bleeding signs. Angio-scan revealed an arteriovenous gastric malformation. Median laparotomy revealed multiple radiologically unsuspected great omentum arteriovenous malformations and confirmed the existence of this arteriovenous malformation in the posterior part of the lesser curvature guided by per-operative esophagogastroduodenoscopy. Atypical gastrectomy was performed. DISCUSSION Our case illustrated a rare life-threatening condition with a challenging diagnosis. Arteriovenous gastric malformation accounted for 1 to 2 % of nonvariceal upper gastrointestinal bleeding. Great omentum localization corresponded to an exceptional condition that had been reported in only one adult patient and one childhood case. Its pathogenesis is still unknown. CONCLUSIONS Arteriovenous gastric malformation had to be considered in case of normal endoscopic esophagogastroduodenoscopy. Computed tomography had to be done for both diagnosis and therapeutic purposes.
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Affiliation(s)
- Sana Landolsi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Aymen Saidi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Soumaya Ncibi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of gastro-enterology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Lamia Kallel
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of gastro-enterology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Imen Ridene
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of radiology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
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Tessier S, Lipton BA, Ido F, Longo S, Nanda S. Pathogenesis and therapy of arteriovenous malformations: A case report and narrative review. Int J Crit Illn Inj Sci 2021; 11:167-176. [PMID: 34760664 PMCID: PMC8547675 DOI: 10.4103/ijciis.ijciis_127_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/24/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022] Open
Abstract
Arteriovenous malformations (AVMs) are abnormal communications between arteries and veins that lack intervening capillary beds. They have been described in almost every organ in the body, emerging sporadically or as part of well-described syndromes. Hereditary hemorrhagic telangiectasia (HHT) is a rare, progressive, and lifelong disease characterized by AVMs and recurrent hemorrhaging. In the last 2 decades, significant advances have been made in understanding the pathogenesis of this condition. The accumulation of knowledge has led to a natural evolution of therapy, from open surgery to endovascular procedures, and now to a role for medications in certain AVMs. Here, we review a case of HHT and describe the most up-to-date clinical practice, including diagnosis of HHT, subtypes of HHT, and medical therapy.
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Affiliation(s)
- Steven Tessier
- Lewis Katz School of Medicine, Temple University, Philadelphia, USA
| | - Brooke A Lipton
- Lewis Katz School of Medicine, Temple University, Philadelphia, USA
| | - Firas Ido
- Department of Pulmonary and Critical Care, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Santo Longo
- Department of Pathology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sudip Nanda
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
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Tortora A, Marmo C, Gasbarrini A, Costamagna G, Riccioni ME. Management of Gastrointestinal Bleeding in Rendu-Osler Disease. Rev Recent Clin Trials 2021; 15:321-327. [PMID: 32493201 DOI: 10.2174/1574887115666200603160033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT, or Rendu-Osler-Weber disease) is a rare inherited syndrome, characterized by artero-venous malformations (AVMs or telangiectasia) with autosomal dominant transmission. AVMs can occur in any organ of the body but most commonly it occurs in the nose, pulmonary, hepatic and cerebral circulations. In patients with HHT, we report teleangectasia of mucosa of the gastrointestinal tract. METHODS Research and online content related to HHT online activity is reviewed, and DOC writing excerpts are used to illustrate key themes. RESULTS Patients with HHT have a high rate of complications related to bleeding; of them gastrointestinal bleeding accounts for 10.8%. Several therapies, both medical and endoscopic, were utilized to reduce the need for transfusions and hospitalization. CONCLUSION A combination of medical and endoscopic therapy is probably the best option.
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Affiliation(s)
- Annalisa Tortora
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Clelia Marmo
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Antonio Gasbarrini
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Guido Costamagna
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
| | - Maria Elena Riccioni
- Department of Gastroenterological, Fondazione Policlinico Gemelli IRCCS, Endocrino-Metabolic, and Nefro-urological Science, Rome, Italy
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Tortora A, Riccioni ME, Gaetani E, Ojetti V, Holleran G, Gasbarrini A. Rendu-Osler-Weber disease: a gastroenterologist's perspective. Orphanet J Rare Dis 2019; 14:130. [PMID: 31174568 PMCID: PMC6555961 DOI: 10.1186/s13023-019-1107-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
Hereditary hemorrhagic teleangectasia (HHT, or Rendu-Osler-Weber disease) is a rare inherited syndrome, characterized by arterio-venous malformations (AVMs or Telangiectasia). The most important and common manifestation is nose bleeds (epistaxis). The telangiectasias (small AVMs) are most evident on the lips, tongue, buccal mucosa, face, chest, and fingers, however; large arterio-venous malformations can also occur in the lungs, liver, pancreas, or brain. Telangiectasias in the upper gastrointestinal tract are known to occur, however data regarding possible small-bowel involvement is limited due to technical difficulties in visualizing the entire gastrointestinal tract. The occurrence of AVMs in the stomach and small bowel can result in chronic bleeding and anaemia. Less frequently, this may occur due to bleeding from oesophageal varices, as patients with HHT can develop hepatic parenchymal AVMs or vascular shunts which cause hepatic cirrhosis and portal hypertension. Gastroenterologists have a crucial role in the management of these patients, however difficulties remain in the detection and management of complications of HHT in the gastrointestinal tract.
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Affiliation(s)
- Annalisa Tortora
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy. .,Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Maria Elena Riccioni
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Eleonora Gaetani
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Veronica Ojetti
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Grainne Holleran
- Department of Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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Martín-Llahí M, Albillos A, Bañares R, Berzigotti A, García-Criado MÁ, Genescà J, Hernández-Gea V, Llop-Herrera E, Masnou-Ridaura H, Mateo J, Navascués CA, Puente Á, Romero-Gutiérrez M, Simón-Talero M, Téllez L, Turon F, Villanueva C, Zarrabeitia R, García-Pagán JC. Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:538-580. [DOI: 10.1016/j.gastrohep.2017.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
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Fernández Gómez-Cruzado L, Prieto Calvo M, Alonso Calderón E, Larrea Oleaga J, Marquina Tobalina T. Conservative management of massive pneumoperitoneum after argon plasma coagulation. Cir Esp 2017; 96:56-58. [PMID: 28410629 DOI: 10.1016/j.ciresp.2017.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Mikel Prieto Calvo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - Eva Alonso Calderón
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - Jasone Larrea Oleaga
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - Teresa Marquina Tobalina
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
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