Laparoscopy and methylene blue staining angiography for precise synchronous resection of small intestinal vascular malformations: a case report.

Background: Chronic intestinal bleeding caused by vascular malformations is uncommon. Locating these small intestinal vascular malformations with precision during surgery remains a challenge. With the rapid development of digital subtraction angiography (DSA), the detection of small intestinal vascular malformations has become easier. However, heterochronous resection of the diseased small intestine may still have negative results, even with the accurate location of the malformed vessels because of the quick excretion of the contrast agent.

Case Summary: A 69-year-old woman presented with recurrent melena lasting for over 3 years, including a recent aggravation 2 days prior to admission. DSA revealed abnormal contrast uptake in the distal part of the first branch of the left superior mesenteric artery. Enhanced computed tomography (CT) scan confirmed the presence of vascular malformations in the small intestine. DSA and methylene blue staining were further utilized in a hybrid operating room to locate the vascular malformation of the small intestine. Laparoscopy-assisted synchronous resection of the stained intestine was performed simultaneously, effectively resolving the intestinal bleeding associated with the malformed vessels. The patient was discharged on postoperative day 5, without complication. She experienced no complications, such as intestinal fistula and hematochezia, at the 6-month follow-up.

Conclusion: With increased experience, laparoscopy and methylene blue staining angiography may offer a safe and feasible method for synchronous resection of small intestine vascular malformations.