A Case of Traumatic Inferior Mesenteric Arteriovenous Fistula

Dong Ok Jeon; Ju Sang Park; Ji Eun Kim; Sang Jin Lee; Hyo Jin Cho; Sung Gyu Im; Il Dong Kim; Eun Mee Han

doi:10.4166/kjg.2013.62.5.296

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Jeon, Park, Kim, Lee, Cho, Im, Kim, and Han: A Case of Traumatic Inferior Mesenteric Arteriovenous Fistula

Case Report

Korean J Gastroenterol 2013;62(5):296-300.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.5.296

A Case of Traumatic Inferior Mesenteric Arteriovenous Fistula

Dong Ok Jeon, Ju Sang Park, Ji Eun Kim, Sang Jin Lee, Hyo Jin Cho, Sung Gyu Im, Il Dong Kim¹, Eun Mee Han²

Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea

¹Department of Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea

²Department of Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea

Correspondence to: Ju Sang Park, Department of Internal Medicine, Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 463-774, Korea. Tel: +82-31-779-0209, Fax: +82-31-779-0897, E-mail: parkjs@dmc.or.kr

Received 27 March 2013 Revised 9 May 2013 Accepted 10 May 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.

Keywords: Inferior mesenteric artery, Arteriovenous fistula, Abdominal injuries

References

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Fig. 1.

(A, B) Abdominal and pelvic CT. Mesenteric thickening producing a mass-like appearance is noted (white arrows).

Fig. 2.

Colonoscopic findings. Diffuse mucosal edema with mild hyperemia is noted from mid rectum up to mid descending colon.

Fig. 3.

Inferior mesenteric arteriogram. (A) Arterial phase shows multiple (about five) fine fistulous communications (white arrows) between left colic artery (LCA) proximal descending colon branch and inferior mesenteric vein (IMV). (B) Late arterial phase shows early opacification of IMV with multifocal narrowing (black arrow). (C, D) Venous phase shows retrograde filling of left colic vein (LCV), sigmoidal vein (SV), and superior rectal vein (SRV) and complete occlusion at proximal portion of IMV (black arrows).

Fig. 4.

Gross finding. (A) Several segments of blood vessels with attached fat tissue are noted (measuring up to 11×2 cm). Microscopic pathologic findings (B, C) show thick walled vein with congestion (H&E stain; B, ×10; C, ×200).

Table 1.

Characteristics of the 19 Cases of Inferior Mesenteric Ateriovenous Fistula

Author	Age (yr)/ sex	Etiology d	Interval to diagnosis (yr	) Symptoms P	Portal hypertension bowel ischemia	n/ Treatment
Van Way et al.¹	72/F	Congenital	NS	Abdominal pain	+/−	Left colectomy
Baranda et al.²	69/F	Congenital	NS	Diarrhea	+/−	Left colectomy
Capron et al.³	60/F	Postoperative	11	Abdominal pain	−/+	Intraarterial embolization
Fabre et al.⁴	NS/M	Postoperative	20	Abdominal pain	+/+	Intraarterial embolization
Hirner et al.⁵	43/F	Postoperative	15	Abdominal pain	+/−	Surgical excision
Houdard et al.⁶	50/F	Postoperative	3	Abdominal pain	−/+	Left colectomy
				Diarrhea
Kim et al.⁷	46/M	Congenital	NS	Abdominal pain	−/+	Left colectomy
				Diarrhea
Manns et al.⁸	33/M	Congenital	NS	Diarrhea	+/−	Left colectomy
Matsui et al.⁹	64/M	Congenital	NS	Diarrhea	−/−	Intraarterial embolization
Metcalf et al.¹⁰	50/M	Congenital	NS	Abdominal pain	−/+	Left colectomy
				Diarrhea
Okada et al.¹²	69/F	Postoperative	8	Abdominal mass	+/−	Left colectomy
Oyama et al.¹³	70/M	Congenital	NS	Abdominal mass	−/−	Left colectomy
Peer et al.¹⁴	63/M	Postoperative	0.5	Abdominal pain	+/−	Left colectomy
				Diarrhea
Pietri et al.¹⁵	72/M	Postoperative	NS	Abdominal mass	+/+	Left colectomy
	60/F	Postoperative	NS	Abdominal mass	−/−	Intraarterial embolization
				Diarrhea
Sabatier et al.¹⁶	22/M	Congenital	NS	Abdominal mass	−/−	NS
Tomomi et al.¹⁷	74/M	Postoperative	15	Abdominal pain	+/−	Surgical excision
Türkvatan et al.¹⁸	83/M	Congenital	NS	Abdominal pain	−/+	Left colectomy
				Diarrhea
Present case	53/F	Traumatic	37	Abdominal pain	−/−	Surgical excision
				Abdominal mass

M, male; F, female; NS, not specified.

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