title: Successful resection of complicated bleeding arteriovenous malformation of the jejunum in patients starting dual-antiplatelet therapy just after implanting a drug-eluting coronary stent.
abstract: We report a case of a 57-year-old man who started dual-antiplatelet therapy with aspirin and clopidogrel following implantation of drug-eluting coronary stent and developed persistent active gastrointestinal bleeding. After detecting the origin of bleeding by double-balloon enteroscopy, successful laparoscopy-assisted partial jejunal resection was performed and the patient condition was promptly recovered, without any thrombotic or bleeding complications. Pathology revealed arteriovenous malformation of the jejunum without any malignancy. We should care for and be aware of this lesion as a rare cause of gastrointestinal bleeding when strong antithrombotic therapy is initiated. Under rigorous assessment and perioperative management, as well as meticulous intraoperative dissection and haemostasis, satisfactory outcome was achieved even in this complicated situation.
authors.affiliation: Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan. fujikawa-t@kokurakinen.or.jp
authors.forename: Takahisa
authors.initials: T
authors.lastname: Fujikawa
authors.forename: Hisatsugu
authors.initials: H
authors.lastname: Maekawa
authors.forename: Kei
authors.initials: K
authors.lastname: Shiraishi
authors.forename: Akira
authors.initials: A
authors.lastname: Tanaka
mesh_terms: D001165:Arteriovenous Malformations / Q000150:complications* / Q000473:pathology / Q000601:surgery; D001241:Aspirin / Q000009:adverse effects*; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin