Abstract
This paper is a case report describing a boy with Down syndrome and a novel combination of multiple vascular anomalies: extrahepatic portal hypertension, an arterio-venous malformation (AVM) at the ileo-caecal junction, and caval/iliac vein anomalies and developing anal bleeding. We considered that the ileo-caecal AVM would be one of the causes of the repeated hematochezia. The patient underwent ileo-caecal resection with the AVM, and anastomosis of the left external iliac vein and the jejunal branch vein because of the stenosis of the superior mesenteric vein (Clatworthy mesocaval shunt). Intraoperative portal pressure measurement at the site of the right colic vein showed a moderate pressure reduction (42.5–31.5 cm H2O). On the fourth month after operation, gastrointestinal fiberscopy showed no existence of esophageal varices. One year after operation, the patient was doing well without bleeding.
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References
Yachha SK, Khanduri A, Sharma BC et al (1996) Gastrointestinal bleeding in children. J Gastroenterol Hepatol 11:903–907
Meyer CT, Troncale FJ, Galloway S et al (1981) Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine 60:36–48
de la Torre L, Carrasco D, Mora MA et al (2002) Vascular malformations of the colon in children. J Pediatr Surg 37:1754–1757
Rieger J, Hosten N, Neumann K et al (1996) Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations. Neuroradiology 38:245–251
Cavett CM, Selby JH, Hamilton JL et al (1977) Arteriovenous malformation in chronic gastrointestinal bleeding. Ann Surg 185:116–121
Kurihara H, Mochizuki H, Yamamoto S et al (1994) Massive intestinal bleeding caused by an ileal arteriovenous malformation: report of a case. Surg Today 24:552–555
Manns RA, Vickers CR, Chesner IM et al (1990) Portal hypertension secondary to sigmoid colon arteriovenous malformation. Clin Radiol 42:203–204
Michalowicz B, Pawlak J, Malkowski P et al (2003) Intraabdominal arterio-venous fistulae and their relation to portal hypertension. Hepatogastroenterology 50:1996–1999
Zargar SA, Yattoo GN, Javid G et al (2004) Fifteen-year follow up of endoscopic injection sclerotherapy in children with extrahepatic portal venous obstruction. J Gastroenterol Hepatol 19:139–145
Evans S, Stovroff M, Heiss K et al (1995) Selective distal splenorenal shunts for intractable variceal bleeding in pediatric portal hypertension. J Pediatr Surg 30:1115–1118
Gauthier F, De Dreuzy O, Valayer J et al (1989) H-type shunt with an autologous venous graft for treatment of portal hypertension in children. J Pediatr Surg 24:1041–1043
Gehrke I, John P, Blundell J et al (2003) Meso-portal bypass in children with portal vein thrombosis: rapid increase of the intrahepatic portal venous flow after direct portal hepatic reperfusion. J Pediatr Surg 38:1137–1140
D’Cruz K, Natarajan A (2001) Emergency inferior mesenteric vein to left renal vein shunt in variceal bleeding: an alternative technique. Trop Gastroenterol 22:230–231
Clatworthy HW Jr (1990). Big shunts for small patients with portal hypertension: a bit of history. J Pediatr Surg 25:1082–1084
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Tatekawa, Y., Muraji, T. & Tsugawa, C. Ileo-caecal arterio-venous malformation associated with extrahepatic portal hypertension: a case report. Ped Surgery Int 21, 835–838 (2005). https://doi.org/10.1007/s00383-005-1524-4
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DOI: https://doi.org/10.1007/s00383-005-1524-4