Hybrid surgical and endovascular management of severe gastrointestinal hemorrhage from mesenteric arteriovenous malformation

Mesenteric arteriovenous malformation is a rare vascular anomaly that can worsen portal hypertension and cause life-threatening gastrointestinal bleeding. We report a 37-year-old man with chronic portal and mesenteric vein thrombosis who presented with recurrent hematochezia refractory to endoscopic and medical therapy. Imaging demonstrated diffuse mesenteric arteriovenous malformation with venous congestion. A staged hybrid strategy was performed: selective embolization reduced shunt flow, followed by bowel resection and creation of a mesocaval shunt. Histopathology confirmed extensive venous abnormalities. The patient recovered uneventfully, and no recurrent bleeding occurred during 9 months of follow-up.