A Unique Case of Small Bowel Arteriovenous Malformations in the Setting of Immune Thrombocytopenic Purpura

Authors

Austin Moore, HCA HealthcareFollow
Evan Chen, HCA HealthcareFollow
Hassan Ahmed, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Plano

Specialty

General Surgery

Document Type

Poster

Publication Date

2025

Keywords

AVM, arteriovenous malformation, arteriovenous malformation of the gastrointestinal tract

Disciplines

Cardiovascular Diseases | Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Medicine and Health Sciences | Surgery

Abstract

Arteriovenous malformations (AVM) are a common cause of gastrointestinal (GI) bleeding and often require intervention for definitive treatment. The diagnosis and management of this disease process becomes complicated when combined with an immunologic coagulation disorder. There is very limited literature describing management techniques for patients with these coinciding diseases. This unique case describes a 65-year-old male with a history of AVMs of the small bowel as well as immune thrombocytopenic purpura (ITP). Previously he had undergone multiple medical interventions for management of his ITP, including steroids and intravenous immunoglobulin therapy. He had also undergone multiple imaging and endoscopic interventions to control spontaneous hemorrhages from AVMs in his G.I. tract. Having concurrent AVMs of the G.I. tract as well as ITP caused him to face multiple instances of G.I. hemorrhage throughout his life, instances which had increased in frequency over the last year. The decision was made to pursue surgical intervention. We performed an exploratory laparotomy with the use of intraoperative small bowel endoscopy to locate portions of bowel with with evidence of active or recent bleeding from AVMs. Two small bowel resections were carried out in these areas, each with a primary anastomosis. Preoperatively it was decided the best course of action to concurrently treat this patient’s ITP was a splenectomy, which was simultaneously performed during this operation. Due to this patient’s increase in instances of G.I. hemorrhage, he had developed chronic anemia requiring numerous blood transfusions despite being on appropriate medical therapy to attempt to control his ITP. This proved to be a unique case where a combination of methods of surgical management were employed to offer this patient a better quality of life. These efforts required extensive coordination and communication with the gastroenterology team to offer this patient thorough evaluation prior to and during surgical intervention to properly isolate areas of bleeding within his bowel that could be resected. From this case, it was important to obtain the most benefit out of a single operation by addressing two different disease processes in the same procedure, in this case by performing a small bowel resection for his AVMs and a splenectomy to definitively treat his ITP.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Moore, Austin; Chen, Evan; and Ahmed, Hassan, "A Unique Case of Small Bowel Arteriovenous Malformations in the Setting of Immune Thrombocytopenic Purpura" (2025). North Texas Research Forum 2025. 65.
https://scholarlycommons.hcahealthcare.com/northtexas2025/65