Mesenteric arteriovenous malformation
Two-year history of worsening postprandial abdominal pain and associated weight loss. The patient reports undergoing a gastric sleeve procedure 10 years prior.
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There is a large mesenteric arteriovenous malformation arising from the superior mesenteric artery with a large nidus and multiple draining veins. The dominant draining vein terminates at the portal confluence. There are multiple jejunal and ileal arterial feeders. Mesenteric edema and trace ascites are associated with the malformation. Prominent wall thickening and relative hypoenhancement of the distal ileum and proximal colon is likely ischemic secondary to steal phenomenon. Subsequent arteriogram confirmed these findings, and demonstrated no supply from the celiac axis or inferior mesenteric artery.
Arteriovenous malformations (AVM) of the visceral arteries are an uncommon cause of abdominal pain. In this case, the patient's abdominal pain was presumably steal syndrome from the AVM resulting in ischemic enteritis/colitis. AVMs can be congenital or secondary to a prior insult. In the abdominal compartment, secondary AVMs can be due to trauma, surgery, or injury during endovascular interventions. The clinical presentation is varied, and can include abdominal pain, diarrhea, hematochezia, and sequelae of portal hypertension (ascites, variceal bleeding).
CT will show an abnormal, disorganized tangle of vessels without a discrete soft tissue mass. When steal phenomenon results in bowel ischemia, the most common sign is wall thickening in the affected vascular distribution. Mesenteric congestion and ascites are additional findings, although may not be present in all cases.
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