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):67–70.         [ 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):36–48.         [ 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

PT–4434-502 Vila Nova de Gaia (Portugal)

E-Mail mafalda_m_p_sousa@hotmail.com

 

Received: October 14, 2018; Accepted after revision: October 19, 2018