Laparoscopic resection of a small intestinal venous malformation presenting as acute bowel obstruction without hemorrhage in a child: a case report.

BACKGROUND

Small intestinal venous malformation is a rare vascular anomaly that most commonly presents with gastrointestinal bleeding. Its manifestation as acute bowel obstruction without hemorrhage is exceedingly uncommon, especially in children, posing a diagnostic dilemma.

CASE DESCRIPTION: A previously healthy 9-year-old boy presented with acute abdominal pain and vomiting. Contrast-enhanced computed tomography revealed a homogeneously enhancing lesion with persistent enhancement on portal venous phase in the left pelvic small bowel, raising suspicion of a vascular malformation. Diagnostic laparoscopy was subsequently performed, identifying a 5 cm segment of small intestine with its serosal surface densely covered by tortuous vessels. Laparoscopic segmental resection with primary hand-sewn end-to-end anastomosis was performed. Immunohistochemistry revealed CD31 and CD34 positivity in lesional endothelial cells and GLUT-1 negativity, excluding infantile hemangioma. This immunoprofile, together with the characteristic morphology, supported the diagnosis of a venous malformation according to the International Society for the Study of Vascular Anomalies (ISSVA) classification. The patient recovered uneventfully and remained asymptomatic with no evidence of residual lesion or symptom relapse during a 6-month follow-up period.

CONCLUSIONS

This case suggests that a small intestinal venous malformation can rarely present as acute obstruction in the absence of bleeding. Contrast-enhanced CT with persistent enhancement pattern is a useful preoperative indicator, and laparoscopy appears to be a feasible approach for both diagnosis and minimally invasive resection. This integrated diagnostic and therapeutic strategy should be considered in select children with small bowel obstruction of uncertain etiology.