A case of arteriovenous malformation of ileum presented by ileus

Most intestinal arteriovenous malformations involve digestive tract bleeding. We report a rare case of ileus without bleeding. A 71-year-old man admitted for abdominal pain and vomiting had an appendectomy at age26, laparotomic distal gastrectomy for gastric carcinoma at 62, and ileus treated conservatively at 67. Abdominal examination showed bulging, soft, mild tenderness around the umbilicus but palpated no mass. Laboratory data showed only mild anemia. Based on abdominal plane computed tomography (CT), we diagnosed adhesive ileus that temporarily improved in conservative therapy, followed by ileus relapse after meal intake. Abdominal enhanced CT showed ileal stenosis but no mass. Based on a diagnosis of relapsing adhesive ileu, we conducted partial ileectomy because intraoperative findings showed ileal stenosis caused by funiform cord but not adhesion. The resected specimen showed transmural proliferation of abnormal vessels with endoarterial fibroelastosis with neural and adipose tissue proliferation around abnormal vessels. The final diagnosis was arteriovenous malformation of the ileum.