Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8298
Revised: March 13, 2014
Accepted: April 5, 2014
Published online: July 7, 2014
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.
Core tip: Inferior mesenteric arteriovenous fistulas are rare, with only 26 known cases described in the literature. This case report describes the diagnostic and therapeutic approach to a new case of a fistula in the inferior mesenteric artery and vein along with a complete literature review. The pathophysiologic, clinical and diagnostic aspects are explored in order to raise awareness of this rare condition.