Ann Surg Treat Res.  2017 Oct;93(4):225-228. 10.4174/astr.2017.93.4.225.

Inferior mesenteric arteriovenous fistula

• Lee S
• Chung J
• Ahn B
• Lee S
• Baek S

• KMID: 2392373
• DOI: http://doi.org/10.4174/astr.2017.93.4.225

Abstract

Arteriovenous fistula (AVF) involving the inferior mesenteric artery and vein is very rare with only 33 cases described in the literature and may be of congenital or acquired (iatrogenic or traumatic) or idiopathic etiology. The pathophysiology of AVF that acts as a left-to-right shunt has accounted for clinical signs and symptoms associated with ischemic colitis, portal hypertension, and heart failure. A low incidence and nonspecific clinical signs and symptoms such as abdominal pain, thrill and mass, lower and upper gastrointestinal bleeding make it difficult to establish a diagnosis of inferior mesenteric AVF. Diagnosis of inferior mesenteric AVF is usually established by radiological or intraoperative examination. We report a case of idiopathic inferior mesenteric AVF causing ischemic colitis in a 56-year-old man that was diagnosed preoperatively by multidetector computed tomography and angiography and successfully treated by surgical resection.

Keyword

Arteriovenous fistula; Inferior mesenteric artery; Ischemic colitis; Portal hypertension

MeSH Terms

Abdominal Pain
Angiography
Arteriovenous Fistula*
Colitis, Ischemic
Diagnosis
Heart Failure
Hemorrhage
Humans
Hypertension, Portal
Incidence
Mesenteric Artery, Inferior
Middle Aged
Multidetector Computed Tomography
Veins

Figure

• 

  Fig. 1 (A) Colonoscopy shows abnormal colonic mucosa with multiple ulcer, exudate and hemorrhage from the splenic flexure to the upper rectum. (B) CT scan (axial view) reveals edematous, thickened and hypoenhanced wall of sigmoid colon with adjacent fat stranding (arrow) in arterial phase.

• 

  Fig. 2 Multidetector computed tomographic angiography (axial image) shows an arteriovenous communication (star) supplied by dilated inferior mesenteric artery (arrow) with venous drainage into dilated marginal vein (arrowhead).

• 

  Fig. 3 Multidetector computed tomographic angiography (3-dimensional volume-rendered image) shows enlarged fistulous communication (arrow) supplied from inferior mesenteric artery (star) with venous drainage into splenic (white curved arrow) and superior mesenteric vein (black curved arrow) via marginal vein (arrow heads).

• 

  Fig. 4 Early (A), middle (B), late (C) arterial phase images from angiography of the inferior mesenteric artery shows nidus of fistula (black arrow) supplied by inferior mesenteric artery (star). There is prompt filling of dilated marginal vein (arrow head) with drainage into splenic, superior mesenteric (curved arrow) and portal vein (white arrow). The inferior mesenteric vein is occluded.

Reference

1. Athanasiou A, Michalinos A, Alexandrou A, Georgopoulos S, Felekouras E. Inferior mesenteric arteriovenous fistula: case report and world-literature review. World J Gastroenterol. 2014; 20:8298–8303.

2. Justaniah AI, Molgaard C, Flacke S, Barto A, Iqbal S. Congenital inferior mesenteric arteriovenous malformation presenting with ischemic colitis: endovascular treatment. J Vasc Interv Radiol. 2013; 24:1761–1763.

3. Hendy P, Cheng EH, Livsey R, Mortimore M. Curative embolization of an inferior mesenteric arteriovenous fistula causing ischaemic proctosigmoiditis. ANZ J Surg. 2015 Oct 13 [Epub]. DOI: 10.1111/ans.13346.

4. Faghihi Langroudi T, Shabestari AA, Pourghorban R, Pourghorban R. Idiopathic inferior mesenteric arteriovenous fistula: a rare cause of pulsatile abdominal mass. Indian J Surg. 2015; 77:Suppl 1. 84–86.

5. Noor M, Cooper K, Lujan H, Pena C. Arteriovenous malformation of the inferior mesenteric artery presenting as ischemic colitis. Vasc Med. 2016; 21:555–557.

6. Carbonell S, Ortiz S, Enriquez P, Lluis F. Arteriovenous fistula in the inferior mesenteric territory. Cir Esp. 2014; 92:e23.

7. Jeon DO, Park JS, Kim JE, Lee SJ, Cho HJ, Im SG, et al. A case of traumatic inferior mesenteric arteriovenous fistula. Korean J Gastroenterol. 2013; 62:296–300.

8. Van Way CW 3rd, Crane JM, Riddell DH, Foster JH. Arteriovenous fistula in the portal circulation. Surgery. 1971; 70:876–890.

9. Okada K, Furusyo N, Sawayama Y, Ishikawa N, Nabeshima S, Tsuchihashi T, et al. Inferior mesenteric arteriovenous fistula eight years after sigmoidectomy. Intern Med. 2002; 41:543–548.

10. Capron JP, Gineston JL, Remond A, Lallement PY, Delamarre J, Revert R, et al. Inferior mesenteric arteriovenous fistula associated with portal hypertension and acute ischemic colitis. Successful occlusion by intraarterial embolization with steel coils. Gastroenterology. 1984; 86:351–355.