A rare case of small bowel arteriovenous malformation presenting as obscure gastrointestinal bleeding

Abstract

Lower gastrointestinal (GI) bleeding (LGIB) is a common surgical condition, which is frequently encountered in the emergency department. The most common origin of LGIB is from the colo-rectal region. However, in majority of cases where no apparent bleeding source is identified, small bowel is the area of concern. Here, we report an uncommon cause of small bowel bleeding that manifested as LGIB. A 63-year-old woman presented to emergency department with 2-day history of dark red rectal bleeding. The upper and lower GI endoscopy did not reveal any source of bleeding. Due to the ongoing blood loss, the hemoglobin level dropped significantly, necessitating blood transfusion. Subsequently, an emergency computed tomography mesenteric angiogram was performed, which showed extravasation of contrast into the distal ileum. She underwent a laparotomy where an arteriovenous malformation of the ileum was noticed. A limited ileal resection was performed, followed by primary anastomosis. She recovered well post-operatively with no further bleeding.