Capsule Endoscopy and Laparoscopy for Small Intestine Arteriovenous Malformation in a Child
Mohamed Adam Shaban, MD, Gustavo Stringel, MD, MBA, Daniel Helfgott, Lynnette Cukaj, MD, Shilpa Sood, MD, Howard Bostwick, MD
Department of Pediatric Gastroenterology, NY Medical College, Westchester Medical Center, Valhalla, New York, USA (Drs Shaban, Cukaj, Sood, and Bostwick).
Department of Surgery, Division of Pediatric Surgery, NY Medical College, Westchester Medical Center, Valhalla, New York, USA (Dr Stringel).
New York Medical College, Westchester Medical Center, Valhalla, New York, USA (Dr. Helfgott).
Introduction: Vascular malformations remain a rare cause of gastrointestinal (GI) bleeding, and they can present a diagnostic challenge. The diagnostic utility of video capsule endoscopy in identifying these malformations in the pediatric population is not well documented.
Case Description: A 7-y-old male with chronic iron deficiency anemia had a clinical history of melon and occasional hematochezia of 1-year duration requiring multiple admissions to the hospital and blood transfusions. Ultrasound, Meckel scan, magnetic resonance imaging, and computed tomography (angiogram) did not demonstrate the source of bleeding. Upper and lower endoscopy studies showed no abnormalities. A video capsule endoscopy showed a lesion in the small intestine suggestive of an arteriovenous malformation. Diagnostic laparoscopy identified the vascular malformation in the mid jejunum. Laparoscopic-assisted intestinal resection including the malformation was successfully performed. After surgical resection, the anemia resolved, and the patient had no further episodes of bleeding.
Conclusions: This case illustrates the utility of video capsule endoscopy combined with laparoscopy in the management of a suspected GI arteriovenous malformation in pediatric patient.
Key Words: Anemia; Arteriovenous Malformation; Gastrointestinal Bleeding; Laparoscopy; Pediatric; Video Capsule Endoscopy.