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Case Reports
. 2017 Oct 17:7:40.
doi: 10.4103/jcis.JCIS_57_17. eCollection 2017.

Massive Left-sided Congestive Colitis Due to Idiopathic Inferior Mesenteric Arteriovenous Malformation

Laura Martí Gelonch  1 , Jose Maria Enríquez-Navascués  2 , Tania Pastor Bonel  1 , Yolanda Saralegui Ansorena  2
Affiliations
Case Reports

Massive Left-sided Congestive Colitis Due to Idiopathic Inferior Mesenteric Arteriovenous Malformation

Laura Martí Gelonch et al. J Clin Imaging Sci. .

Abstract

Arteriovenous malformations (AVM) of the inferior mesenteric artery are rare. They may be primary (congenital or idiopathic) or secondary (acquired) after trauma or of iatrogenic origin. Of the abdominal AVM, the inferior mesenteric trunk is the least commonly involved. Most reported cases are of iatrogenic origin, resulting from colon surgery. Only 17 cases have been described and published in the literature. The objective of this work is to make known a case treated in our center. We present a case of 73-year old male, who came to the emergency service with symptoms of abdominal distension, pain lasting 48 hours along with months of diarrhoea. CT scan and an abdominal CT angiography showed a massive left-sided congestive colitis due to idiopathic inferior mesenteric arteriovenous malformation. In our case, the decision was to carry out the treatment in two stages. Embolisation was performed in the first stage in order to decrease the blood flow and the risk of intraoperative bleeding, followed by resective surgery of the affected colon.

Keywords: Arteriovenous malformation; congenital; congestive colitis; inferior mesenteric trunk.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; abdominal ultrasound revealed a portal vein (white arrow) in the high limit of normality (15 mm).
Figure 2
Figure 2
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; (a) transversal computed tomography scan showed wall thickening of the descending colon (white arrow). (b) Coronal image (white arrow showed wall thickening of the descending colon).
Figure 3
Figure 3
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; colonoscopy revealed edema in the left colon.
Figure 4
Figure 4
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; computed tomography angiography of the abdomen and pelvis confirmed a large arterial malformation involving the inferior mesenteric artery (white arrow). Gray arrows revealed abnormal vascularization.
Figure 5
Figure 5
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; arteriography; pre-embolization image (left) and post-embolization image (right). All branches of the inferior mesenteric artery are embolized with microcoils, from the splenic angle to the sigmoid branches, respecting the territory of the upper hemorrhoidal artery.
Figure 6
Figure 6
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; a large draining vein within the transverse mesocolon level was observed intraoperatively (white arrow).
Figure 7
Figure 7
A 73-year-old man with an arteriovenous malformation of the inferior mesenteric artery; resected colon specimen.
See this image and copyright information in PMC

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