Korean J Gastroenterol.  2010 Aug;56(2):113-116. 10.4166/kjg.2010.56.2.113.

A Case of Lower Gastrointestinal Bleeding Caused by Primary Iliac Arterio-colic Fistula

• Kim YI
• Park SY
• Ki WJ
• Ki HS
• Yoon KW
• Kim HS
• Choi SK
• Rew JS

• KMID: 1775867
• DOI: http://doi.org/10.4166/kjg.2010.56.2.113

Abstract

Arterio-enteric fistula is a very rare cause of massive lower gastrointestinal hemorrhage. We report here on a case of massive hematochezia caused by iliac arterio-colic fistula in a 60-year-old woman who had a recent history of spinal surgery for herniated nucleus pulposus. Abdomen computed tomography showed the extravasation of radiocontrast media from right iliac artery encased by an intraabdominal abscess into the adjacent dilatated colon. Also, diagnostic angiography revealed the active extravasation of radiocontrast media via a fistula between right iliac artery and colon. Although successful endovascular exclusion of the fistula with stent graft and coils was performed, disseminated intravascular coagulation and multi-organ failure were developed.

Keyword

Arterio-colic fistula; Gastrointestinal bleeding; Angiography

MeSH Terms

Colonic Diseases/complications/*diagnosis
Female
Gastrointestinal Hemorrhage/*etiology
Humans
Iliac Artery/*radiography
Intestinal Fistula/complications/*diagnosis
Middle Aged
Stents
Tomography, X-Ray Computed
Vascular Fistula/complications/*diagnosis

Figure

• 

  Fig. 1. Abdominal CT scan on emergency room. (A) Non-enhancement abdomen CT scan showed a 3 cm sized soft tissue abscess with mottled air densities (arrows). (B) Post-contrast enhancement CT scan showed right iliac artery within an abscess (arrow head) and extravasation of radiocontrast media into the adjacent dilatated colon (arrows).

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  Fig. 2. Diagnostic selective angiography revealed active extravasation of radiocontrast media via a arteriocolic fistula between right internal iliac artery and colon (arrows).

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  Fig. 3. Successful endovascular exclusion of a right iliac arteriocolic fistula was performed with stent graft (arrows) and coils (arrow head).

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