Occult bleeding of small bowel: endovascular embolization and literature review

Superselective Transcatheter Arterial Embolization in the Treatment of Angiodysplasia

Acute nonvariceal upper gastrointestinal hemorrhage is a frequent condition associated with significant morbidity and mortality. Angiodysplasia is a common cause of bleeding in the gastrointestinal tract in the elderly. This case report discusses about a 75-year-old woman clinically stable with melena for 2 years due to arteriovenous fistula of upper mesenteric artery branches without adequate clinical and therapeutic treatment. The goal of this article is to report the safety and efficacy of superselective transcatheter arterial embolization with coils in treating lower gastrointestinal bleeding caused by angiodysplasia that was unresponsive to internal medicine treatment and enteroscopy management.

Robot-assisted subtotal pancreas-preserving duodenectomy

BACKGROUND

Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance.

METHODS

The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy.

RESULTS

The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage.

CONCLUSION

The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery.

Small bowel ischemia after angiographic embolization for angiodysplasia of lower gastrointestinal tract: the case for conservative management

However, transarterial embolization for angiodysplasia has become widely used, the possibility of complications such as bowel ischemia and infarction still exists. We experienced a 60-year-old woman of small bowel ischemia after angiographic embolization for the angiodysplasia of cecum treated with conservative management. We should consider the possibility of recovery via the rich intramural vascular networks of the lower GI tract before deciding to operate.