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Review
. 2014 Jul 7;20(25):8298-303.
doi: 10.3748/wjg.v20.i25.8298.

Inferior mesenteric arteriovenous fistula: case report and world-literature review

Antonios Athanasiou  1 , Adamantios Michalinos  1 , Andreas Alexandrou  1 , Sotirios Georgopoulos  1 , Evangelos Felekouras  1
Affiliations
Review

Inferior mesenteric arteriovenous fistula: case report and world-literature review

Antonios Athanasiou et al. World J Gastroenterol. .

Abstract

Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.

Keywords: Arteriovenous fistula; Colectomy; Embolization; Inferior mesenteric artery; Portal hypertension.

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Figures

Figure 1
Figure 1
Preoperative computed tomography scan showing edematous sigmoid colon with irregular luminal narrowing within the colonic wall (arrow) and hypoperfusion of the sigmoid colon in the venous phase. SC: Sigmoid colon.
Figure 2
Figure 2
Angiography showing the point of arteriovenous communication (arrows).
Figure 3
Figure 3
Postoperative magnetic resonance angiography showing opacification of the arterial and venous inferior mesenteric system.
Figure 4
Figure 4
Angiography after the embolization of the an arteriovenous fistula sites.
Figure 5
Figure 5
Photo of atrophic and ischemic descending and sigmoid colon.
See this image and copyright information in PMC

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