Moon YJ, Lee SH. Inferior mesenteric arteriovenous fistula: Two case reports. World J Gastrointest Surg 2025; 17(9): 107139 [DOI: 10.4240/wjgs.v17.i9.107139]
Corresponding Author of This Article
Seung-Hun Lee, MD, PhD, Professor, Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, No. 262 Gamcheon-ro, Seo-gu, Busan 49267, South Korea. candoli8182@kosin.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 107139 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.107139
Inferior mesenteric arteriovenous fistula: Two case reports
Yea-Jin Moon, Seung-Hun Lee
Yea-Jin Moon, Seung-Hun Lee, Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, South Korea
Author contributions: Moon YJ performed the literature review; Lee SH designed the study; Moon YJ and Lee SH wrote the paper; Lee SH revised the manuscript accordingly. All the authors have read and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seung-Hun Lee, MD, PhD, Professor, Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, No. 262 Gamcheon-ro, Seo-gu, Busan 49267, South Korea. candoli8182@kosin.ac.kr
Received: March 16, 2025 Revised: April 11, 2025 Accepted: July 18, 2025 Published online: September 27, 2025 Processing time: 192 Days and 7.7 Hours
Abstract
BACKGROUND
Inferior mesenteric arteriovenous fistula (IMAVF) is an uncommon circulatory malformation with few reported instances. It entails a direct arteriovenous communication within the inferior mesenteric vascular system, producing abnormal hemodynamic flow that may result in gastrointestinal hypoperfusion, elevated portal venous pressure, and secondary cardiac dysfunction. Diagnosis often experiences delays because of nonspecific symptoms. Imaging modalities, such as multi-detector computed tomography (MDCT) and angiography, prove essential for accurate diagnosis and treatment planning.
CASE SUMMARY
Over a 10-year period, only two cases of IMAVF were encountered. The initial case involved a 56-year-old male without notable prior medical conditions who experienced intermittent lower abdominal discomfort, diarrhea, and hematochezia over several months. Ischemic colitis with an IMAVF was revealed through colonoscopy and MDCT angiography. Due to the size of the IMAVF, Hartmann’s procedure was performed instead of an endovascular intervention. Recovery proceeded uneventfully, and the colostomy was reversed one year later, with no recurrence observed on follow-up imaging. The subsequent case involved a 76-year-old female with repeated left-sided pyelonephritis and colonic diverticular disease, who manifested with abdominal discomfort and hematochezia. In contrast to previous computed tomography scans, MDCT and angiography revealed a newly developed IMAVF. Given her unstable vital signs, emergency laparoscopic total colectomy with ileorectal anastomosis and temporary ileostomy was conducted. Recovery occurred without complications, and the ileostomy was successfully reversed 2 months later, with no recurrence noted.
CONCLUSION
These cases emphasize the need to evaluate for vascular abnormalities in individuals presenting with ischemic colitis and unexplained gastrointestinal bleeding. The second case demonstrates that recurrent intra-abdominal inflammation may contribute to the development of IMAVF.
Core Tip: Over the past 10 years, we have encountered this rare disease twice. Our initial experience enabled a faster diagnosis and treatment in the second case. We found that recurrent intra-abdominal infection and inflammation may lead to the development of an inferior mesenteric arteriovenous fistula and serve as key indicators in diagnosing ischemic colitis of unknown origin. Although surgical resection may offer a definitive solution, timely diagnosis could make endovascular intervention a viable alternative.
