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Case Reports
. 2023 Jun:107:108322.
doi: 10.1016/j.ijscr.2023.108322. Epub 2023 May 19.

Inferior mesenteric arteriovenous malformation extending to splenic flexure colonic wall presenting with massive lower gastrointestinal bleeding, a case report

Yumna Njoum  1 , Khaled Alshawwa  2 , Bashar Jaber  2 , Omar Abu-Zaydeh  2
Affiliations
Case Reports

Inferior mesenteric arteriovenous malformation extending to splenic flexure colonic wall presenting with massive lower gastrointestinal bleeding, a case report

Yumna Njoum et al. Int J Surg Case Rep. 2023 Jun.

Abstract

Introduction and importance: An arteriovenous malformation (AVM) in the inferior mesenteric artery is a rare vascular pathology that accounts for 6 % of the causes of gastrointestinal bleeding. AVMs are typically classified as congenital persisting embryonic vasculature that link both systems and do not develop into arteries or veins [3], but they may also develop later in life. The majority of documented cases are iatrogenic after colon surgery.

Case presentation: Herein we describe a 56-year-old man who presented complaining of fresh blood per rectum with passage of clots not related to defecation with no previous similar episodes, he was found to have extensive inferior mesenteric branches AVM invading the colonic splenic flexure via Computed Tomography (CT) angiography following three non-revealing upper and lower endoscopies which was later managed surgically with left hemicolectomy with primary end to end colo-colic anastomosis.

Clinical discussion: Although AVMs seldom manifest in multiple sites through the gastrointestinal tract, it is more prevalent in the stomach, small intestine, and ascending colon, and very unusual to affect the Inferior mesenteric artery and vein and to extend to the splenic flexure colonic wall.

Conclusion: Even if rare, inferior mesenteric AVMs should be suspected in a patient presenting with GI Bleeding with unrevealing endoscopies, where CT Angiography is to be considered.

Keywords: Arteriovenous malformation; Case report; Inferior mesenteric artery; Lower gastrointestinal bleeding; Splenic flexure; Surgical resection.

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Conflict of interest statement

Declaration of competing interest There is no conflict of interest.

Figures

Figs. 1, 2, 3
Figs. 1, 2, 3
Axial and coronal CT cuts showing extensive serpiginous enhancing tubular structures affecting left colon wall, noted mainly in the arterial phase. Findings are in-keeping with left colon angiodysplasia, associated with enlarged IMA and its feeding arteries and draining veins. The disease extends to the splenic flexure. The sigmoid is free of disease.
Fig. 4
Fig. 4
Intraoperative finding of tortuous dilated arteriovenous malformation involving mainly the wall of left colon and splenic flexure (arrow).
See this image and copyright information in PMC

References

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