Laparoscopic Resection of Osler-Weber-Rendu Lesion

BACKGROUND AND OBJECTIVES Osler-Weber-Rendu is a hereditary disease characterized by telangiectasias, arteriovenous malformations, and aneurysms involving the cutaneous, gastrointestinal, pulmonary, and central nervous systems. This report describes a combinatorial approach using laparoscopic and intraoperative endoscopy to perform a partial gastric resection of bleeding arteriovenous malformations. METHODS A 70-year-old female with a history of bleeding from Osler-Weber-Rendu disease presented to the emergency department complaining of hematemesis. Her vital signs were unstable, and she was immediately resuscitated with intravenous fluids and transfusions. A combined laparoscopic and intraoperative endoscopic approach to a partial gastric resection was planned. Intraoperatively, a single lesion was identified along the posterior aspect of the greater curvature of the stomach by using endoscopy. The blood supply was taken down with a Ligasure and gastric resection with a 60-mm Echelon stapler. RESULTS The pathology report confirmed the complete resection of the arteriovenous malformations. The patient recovered well and was discharged home several days later without any pain complaints. CONCLUSIONS Little has been written about the medical treatment of Osler-Weber-Rendu arteriovenous malformations, let alone surgical treatment. A combinatorial laparoscopic and intraoperative endoscopic approach to gastric resection allows both minimization of the gastric resection and the complete identification and removal of the arteriovenous malformations.