J Korean Soc Radiol.  2016 Mar;74(3):185-188. 10.3348/jksr.2016.74.3.185.

Idiopathic Inferior Mesenteric Arteriovenous Fistula with Ischemic Colitis: A Case Report and Literature Review

• Kim HY
• Sim JY
• Lee KH
• Kim YH
• Lee YJ
• Park JH

• KMID: 2155278
• DOI: http://doi.org/10.3348/jksr.2016.74.3.185

Abstract

Inferior mesenteric arteriovenous fistula (AVF) is a rare vascular abnormality that may be either congenital or acquired. It usually presents with abdominal pain, gastrointestinal bleeding, and a palpable mass with thrill or portal hypertension; it may also elicit more serious complications such as colonic ischemia. We report a case of idiopathic inferior mesenteric AVF in a 75-year-old man who presented with recurrent ischemic colitis. To our knowledge, this is the first reported case in Korea of an idiopathic inferior mesenteric AVF without any surgical or traumatic history.

MeSH Terms

Abdominal Pain
Aged
Arteriovenous Fistula*
Colitis, Ischemic*
Colon
Hemorrhage
Humans
Hypertension, Portal
Ischemia
Korea
Mesenteric Artery, Inferior

Figure

• 

  Fig. 1 Ischemic colitis caused by an idiopathic inferior mesenteric arteriovenous fistula in a 75-year-old male patient. A. Colonoscopic finding of diffuse mucosal edema with hyperemia is visible from the lower rectum up to the proximal descending colon. B, C. Contrast-enhanced axial CT scan obtained in the portal venous phase (B) demonstrates diffuse and severe colonic wall thickening with submucosal edema (arrows). Pericolic fat stranding and a small amount of pericolic fluid are also noted. CT scan (C) demonstrates abnormally dilated and tortuous vascular branches of the inferior mesenteric vein (arrowheads), especially at the distal end of the superior rectal vessels (arrow). D. 3D volume rendered image demonstrates communication (arrow) between the inferior mesenteric artery (black arrowheads) and the dilated, tortuous mesenteric vein (white arrowheads). E. Selective inferior mesenteric arteriogram demonstrates the dilated distal end of the superior rectal artery (arrow) communicating with the engorged inferior mesenteric vein, resulting in its early opacification (arrowheads). F. Superior mesenteric arteriogram shows a prominent arc of Riolan (arrows), which presumably dilated in order to divert some SMA blood flow to the ischemic left colon. SMA = superior mesenteric artery, 3D = three-dimensional

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