Strjina Veljko, Kelley Scott R
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, USA.
Turk J Gastroenterol. 2017 Sep;28(5):408-411. doi: 10.5152/tjg.2017.17253. Epub 2017 Aug 9.
Refractory chronic colitis presents a medical and surgical challenge, and underlying etiologies are diverse with potential for misclassification as inflammatory bowel disease. We present an unusual case of chronic proctosigmoiditis with rare vascular etiology. A 48-year-old Caucasian male presented with severe diarrhea, weight loss, and abdominal pain. Computed tomography (CT) suggested proctosigmoiditis. Colonoscopy and biopsy findings were non-specific but were suggestive of ischemic etiology and venous congestion. He was initially treated with antibiotics, steroids, and mesalamine, which did not show any improvement. Mesenteric angiography showed a fairly large irregular and bizarre vessel consistent with a large arteriovenous fistula (AVF) associated with one of the branches of the inferior mesenteric artery. AVF was too large to be embolized, and he underwent a laparoscopic low anterior resection with creation of a coloproctostomy and protective diverting loop ileostomy. An AVF was found at the origin of the ascending left colic artery. Inferior mesenteric vein thrombosis and arteriovenous fistulization are rare vascular causes of chronic proctosigmoiditis, but these should be considered in refractory cases. Both initial diagnosis and surgical treatment can be challenging.
难治性慢性结肠炎对医学和外科治疗而言都是一项挑战，其潜在病因多种多样，有可能被误诊为炎症性肠病。我们报告一例罕见血管病因导致的慢性直肠乙状结肠炎的特殊病例。一名48岁的白人男性出现严重腹泻、体重减轻和腹痛。计算机断层扫描（CT）提示直肠乙状结肠炎。结肠镜检查和活检结果不具有特异性，但提示缺血性病因和静脉淤血。他最初接受了抗生素、类固醇和美沙拉嗪治疗，但未见任何改善。肠系膜血管造影显示有一条相当大的不规则且怪异的血管，与肠系膜下动脉的一个分支相关的一个大动静脉瘘（AVF）一致。AVF太大无法栓塞，于是他接受了腹腔镜低位前切除术，并行结肠直肠吻合术和保护性转流性回肠造口术。在左结肠升动脉起始处发现了一个AVF。肠系膜下静脉血栓形成和动静脉瘘是慢性直肠乙状结肠炎罕见的血管病因，但在难治性病例中应予以考虑。初始诊断和手术治疗都可能具有挑战性。
