Open Access
CC BY 4.0 · Journal of Coloproctology 2024; 44(S 01): S1-S138
DOI: 10.1055/s-0045-1808806
Temas Gerais Dentro da Especialidade
General Topics Within the Specialty
ID – 138270
E-poster

SECONDARY ISCHEMIC COLITIS DUE TO ARTERIOVENOUS MALFORMATION AT THE LEVEL OF THE INFERIOR MESENTERIC ARTERY

Lívia Peruzzo Zollinger Nova
1   Coloproctologist at Hospital da Bahia, Salvador, Bahia, Brasil
,
Meyline Andrade Lima
1   Coloproctologist at Hospital da Bahia, Salvador, Bahia, Brasil
,
Carlos Ramon Mendes
1   Coloproctologist at Hospital da Bahia, Salvador, Bahia, Brasil
,
Ticiana Assemany Cruz
2   Medical student, Centro Universitário Dom Pedro II, em Salvador Bahia, Brasil
,
Lorena Boureau Pereira
2   Medical student, Centro Universitário Dom Pedro II, em Salvador Bahia, Brasil
,
Leticia Sandes Bittencourt de Carvalho Melo
3   Medical student, Escola Bahiana de Medicina e Saúde Pública, em Salvador Bahia, Brasil
,
Bruno Franco de Oliveira Santos
3   Medical student, Escola Bahiana de Medicina e Saúde Pública, em Salvador Bahia, Brasil
,
Fabiana Cerqueira Tararam
4   General surgery resident at Hospital Irmã Dulce, em Salvador Bahia, Brasil
› Author Affiliations
 

    Case report This is a 41-year-old male patient who presented with diarrhea accompanied by mucus discharge and bleeding, in addition to abdominal pain, suspected to be infectious colitis, requiring hospitalization. A computed tomography angiography (CTA) was performed, which showed early opacification of the inferior mesenteric vein during the arterial phase of the study, with a tortuous and ectatic appearance, maintaining a direct relationship with branches of the inferior mesenteric artery, suggesting an arteriovenous fistula. A sigmoidoscopy was performed, revealing edema and mucosal erythema in the sigmoid colon, the presence of fibrinous exudate, and ulcers of varying sizes and shapes; the rectum showed mucosal edema, erythematous areas, and obliteration of the submucosal vascular pattern. The patient was treated with intravenous antibiotics but continued to experience abdominal pain and mucus discharge. On physical examination, he had a globular and flaccid abdomen, deep palpation tenderness, and mild pain upon sudden decompression. No change was observed on CTA in a follow-up imaging exam. In laboratory tests in March 2024, the following values were noted: C-reactive protein 61.7; AST 184; ALT 537; GGT 23. Surgical intervention was performed, including left colectomy with the creation of a terminal colostomy in the transverse colon via laparoscopy. The pathological examination concluded active erosive colitis and thrombosis of small vessels.

    Discussion Ischemic colitis is inflammation of the colon due to reduced blood flow to that region, which can occur due to factors such as atherosclerosis, obstruction, and vascular diseases. In rare cases, ischemic colitis can be associated with arteriovenous fistulas, abnormalities connecting arteries to veins, which can result in ischemia or lesions in the colon. The most common associated symptoms are acute abdominal pain, vomiting, diarrhea, or hematochezia, with treatment being either surgical or non-surgical. In addition to physical examination, complementary imaging such as CTA or colonoscopy are used for a more precise diagnosis.

    Conclusion This case highlights the importance of follow-up and the use of complementary tests in diagnosing ischemic colitis associated with arteriovenous fistulas. Early identification and appropriate treatment, including surgical intervention when necessary, are essential for a good prognosis.


    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    25 April 2025

    © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

    Thieme Revinter Publicações Ltda.
    Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil