Emergency Laparoscopic Management of a Yakes Type III b Inferior Mesenteric Arteriovenous Malformation Presenting as a Massive Lower GI Bleed: A Case Report and Literature Review

Abstract One of the less common causes of lower gastrointestinal bleed is the inferior mesenteric artery to vein malformation in the lumen. Here, we present a case where a patient presented with massive lower gastrointestinal bleed, followed by hemorrhagic shock. Contrast-enhanced computed tomography of the abdomen revealed inferior mesenteric artery to vein malformation with transmural sigmoid collaterals. The usual presentation is non-specific abdominal pain, abdominal mass, or manifestations of portal hypertension and colonic ischemia; extreme cases can present with heart failure. The usual management of these arteriovenous malformations is interventional radiological procedures such as embolization, followed by surgical resection as required. In this case, we describe the role and feasibility of emergency laparoscopic management of a bleed within the inferior mesenteric vessel due to arteriovenous malformation. Less than 40 cases have been reported to date.