Li Honghai, Yu Zunfang, Wang JinDao, Zhang Zhenxing, Zhang Guolin, Lu Zengxin, Lv Jieqing, Tao Feng, Jin Qijing
Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China.
Department of Physical Examination Center, Affiliated Hospital of Binzhou Medical University, Binzhou City, Shandong Province, China.
Heliyon. 2023 Feb 11;9(3):e13667. doi: 10.1016/j.heliyon.2023.e13667. eCollection 2023 Mar.
Arteriocolonic fistula of Inferior Mesenteric Artery Aneurysm (IMAA) refers to a spontaneous formation of pathological communication between the artery and the adjacent gastrointestinal tract. It is a rare, life-threatening condition primarily manifesting as abdominal pain, gastrointestinal bleeding, abdominal pulsating masses. However, its clinical manifestations are usually atypical with a difficult diagnosis and treatment.
We report a rare case of a 50-year-old male with a hemorrhagic shock due to primary arteriocolonic fistula of IMAA. Instead of sigmoidectomy, super selective transcatheter arterial embolization (TAE) was performed after diagnostic angiography. Postoperatively, dynamic contrast-enhanced abdominal computed tomography (CT) demonstrated no recanalization of the aneurysm, absence of abnormal collateral vessels, no active hemorrhage. The patient was discharged uneventfully after 2 weeks without abdominal pain or tension.
Colorectal tumor rupture is a major cause of lower gastrointestinal bleeding (LGIB), with IMAA being an uncommon etiology. Because of the high mortality of explorative laparotomy with an unclear bleeding site, diagnostic angiography and therapeutic TAE are viable options for diagnosing hemodynamic instability.
Arteriocolonic fistulas commonly occur secondary to a pseudoaneurysm formed at the anastomosis of the transplanted blood vessel after an artery surgery, which ruptures and penetrates into the intestine. We reported a unique case of primary arteriocolonic fistula of IMAA: aneurysm rupture and bleeding from the abdomen into the hematochezia. After multidisciplinary consultations, our patient obtained the best outcome using the most minimally invasive surgical methods. With an abdominal artery aneurysm presenting with colorectal hemorrhage, arteriocolonic fistula of IMAA should be suspected.
肠系膜下动脉动脉瘤（IMAA）所致的动脉结肠瘘是指动脉与相邻胃肠道之间自发形成的病理性通道。这是一种罕见的、危及生命的疾病，主要表现为腹痛、胃肠道出血、腹部搏动性肿块。然而，其临床表现通常不典型，诊断和治疗都很困难。
我们报告一例罕见病例，一名50岁男性因IMAA原发性动脉结肠瘘导致失血性休克。在诊断性血管造影后，未进行乙状结肠切除术，而是实施了超选择性经导管动脉栓塞术（TAE）。术后，动态对比增强腹部计算机断层扫描（CT）显示动脉瘤未再通，无异常侧支血管，无活动性出血。患者在2周后顺利出院，无腹痛或不适。
结直肠肿瘤破裂是下消化道出血（LGIB）的主要原因，IMAA是一种不常见的病因。由于出血部位不明的剖腹探查术死亡率高，诊断性血管造影和治疗性TAE是诊断血流动力学不稳定的可行选择。
动脉结肠瘘通常继发于动脉手术后移植血管吻合处形成的假性动脉瘤，该假性动脉瘤破裂并穿透至肠道。我们报告了一例独特的IMAA原发性动脉结肠瘘病例：动脉瘤破裂并从腹部出血至便血。经过多学科会诊，我们的患者采用最微创的手术方法获得了最佳治疗效果。当出现腹部动脉动脉瘤并伴有结直肠出血时，应怀疑为IMAA所致的动脉结肠瘘。
