Cheng Ling, Zhao Ruifeng, Guo Di, Cai Kailin, Zou Kaifang, Yang Jun, Zhu Liangru
Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2017 Dec;96(48):e8717. doi: 10.1097/MD.0000000000008717.
Inferior mesenteric arteriovenous fistula (IMAVF) is a rare condition principally characterized by portal hypertension and ischemic bowel disease. Up to now, only 30 cases have been reported. Presented here is an IMAVF patient with nonpulsatile abdominal mass as the main manifestation.
A 62-year-old Chinese male who complained of abdominal discomfort for a month was admitted to our hospital. Physical examination revealed a hard and hardly mobile mass.
Space-occupying lesions were first suspected but endoscopy did not reveal any masses. The computed tomography angiography exhibited no definite boundary between the inferior mesenteric artery and vein. The patient was diagnosed with IMAVF.
The treatment of IMAVF mainly includes intra-arterial embolization and surgery. In our case, fistulas were complex and the patient had symptoms of colon ischemia, so we suggested a surgical resection instead of embolization. And the postoperative biopsy also confirmed the diagnosis.
After surgery, gastrointestinal symptoms disappeared and the patient began to gain weight gradually. During the follow-up, colonoscopy showed that the anastomotic astium and colonic mucosa were normal.
Analysis of the case showed that computed tomography angiography is an important auxiliary examination for establishing the diagnosis of IMAVF and surgery is an effective treatment.
肠系膜下动静脉瘘（IMAVF）是一种罕见疾病，主要特征为门静脉高压和缺血性肠病。截至目前，仅报道了30例。本文介绍了一例以非搏动性腹部肿块为主要表现的IMAVF患者。
一名62岁中国男性因腹部不适1个月入院。体格检查发现一个质地硬且活动度差的肿块。
最初怀疑为占位性病变，但内镜检查未发现任何肿块。计算机断层血管造影显示肠系膜下动脉和静脉之间无明确边界。该患者被诊断为IMAVF。
IMAVF的治疗主要包括动脉内栓塞和手术。在我们的病例中，瘘管情况复杂，且患者有结肠缺血症状，因此我们建议进行手术切除而非栓塞。术后活检也证实了诊断。
手术后，胃肠道症状消失，患者体重开始逐渐增加。随访期间，结肠镜检查显示吻合口和结肠黏膜正常。
该病例分析表明，计算机断层血管造影是确诊IMAVF的重要辅助检查，手术是有效的治疗方法。
