Air embolism during intraoperative endoscopic localization and surgical resection for blue rubber bleb nevus syndrome.

BLUE rubber bleb nevus syndrome, a rare vascular malformation involving the gastrointestinal tract, may result in clinically significant acute and chronic bleeding. The bleeding is generally chronic and unremitting, with continual melena necessitating transfusion or surgical management. Definitive surgical management is frustrating because the lesions are usually multiple (often numbering in the hundreds) and may be found anywhere in gut derivatives from the mouth to the anus, most often in the small intestine. The length of the instruments available and the risks of incomplete removal and perforation limit endoscopic treatment such as sclerotherapy or laser photocoagulation as an alternative. Combined approaches using transoral and transrectal endoscopic examination and endoscopic examination via laparotomy/ enterotomy permit visualization of the entire gastrointestinal tract.