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Maqboul I, Demyati K, Abdoh Q, Suleiman Q, Daraghmeh L. An arteriovenous malformation associated ischemic colitis in the setting of acute gastrointestinal clostridium difficile colitis and intestinal amebiasis: A case report. Int J Surg Case Rep 2023; 105:108063. [PMID: 37004449 PMCID: PMC10112014 DOI: 10.1016/j.ijscr.2023.108063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND There is one reported case of inferior mesenteric arteriovenous malformation presenting as ischemic colitis after an episode of gastrointestinal infection. We documented this case to emphasize the possible association between ischemic colitis and vascular malformations. In addition, this is the number 15th case in the literature about this association. CASE SUMMARY A 40 years old male patient presented with abdominal pain and diarrhea of 10 days duration after he was diagnosed and managed as a case of Clostridium Difficile infection and amebiasis. Computed tomography angiography revealed a vascular malformation of the inferior mesenteric artery, repeated colonoscopy showed ulceration and sloughing of the mucosa, he underwent Hartmann's procedure due to colonic ischemia diagnosed by the previous measures. Later on he had a colostomy closure and end to end colorectal anastomosis. CONCLUSION There is a possible association between acute gastrointestinal infection and ischemic colitis in the setting of arteriovenous malformation.
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Affiliation(s)
- Iyad Maqboul
- Department of Medicine Faculty of Medicine & Health Sciences, An-Najah National University Hospital, State of Palestine.
| | - Khaled Demyati
- An-Najah National University Hospital, State of Palestine.
| | - Qusay Abdoh
- An-Najah National University Hospital, State of Palestine.
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Kai K, Sano K, Higuchi K, Uchiyama S, Sueta H, Nanashima A. A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report. Surg Case Rep 2019; 5:82. [PMID: 31102060 PMCID: PMC6525223 DOI: 10.1186/s40792-019-0630-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Inferior mesenteric arterioportal fistula (APF) is rare as only 35 case reports in the literature. We herein presented a case of simultaneously double cancer in the rectum and stomach with inferior mesenteric APF, which is the first case report by searching using PubMed. Combination of interventional embolization and surgical operation seemed to be optimal treatment for avoiding postoperative complications and the curability. CASE PRESENTATION A 66-year-old male with epigastric pain was admitted to a practitioner. He underwent a gastroscopy with biopsy, and cancer located in the lesser curvature of the gastric cardia was found. Enhanced CT did not reveal wall thickening of the stomach and distant metastases, but several swollen lymph nodes were observed in the right cardia. In the arterial phase, dilation of inferior mesenteric vein (IMV) and superior rectal artery (SRA) were noted, which raised suspicions of an arterioportal communication. Colonoscopy revealed a type 2 rectal tumor located 12 cm from the anal verge. The histological diagnosis of well-differentiated tubular adenocarcinoma was confirmed by biopsy. At a first step, we planned to perform a radiological embolization of inflow vessels to APFs except for SRA. Additionally, we determined the interval time of 1 month between the first low anterior rectal resection and the sequential gastrectomy for the purpose of decreasing portal pressure. The postoperative course was uneventful without hemorrhagic complications, and S-1 was taken internally 1 year as adjuvant chemotherapy for gastric cancer. The patient still lives without recurrence of this cancer with APF and portal vein thrombosis 2.5 years after the aforementioned surgeries. CONCLUSION Inferior mesenteric APF and/or arteriovenous fistula (AVF) would be consisted of the several inflow arteries as superior rectal, internal iliac, and median sacral arteries, and outflow veins as inferior mesenteric, internal iliac, and median sacral veins. To determine the therapeutic strategy for left-sided colorectal cancers with abnormal vessel communications of the pelvis, it is significant to comprehend distribution and component vessels of APF and/or AVF.
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Affiliation(s)
- Kengo Kai
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan.
| | - Koichiro Sano
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Kazuhiro Higuchi
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Shuichiro Uchiyama
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Hideto Sueta
- Department of Surgery, Miyakonojo Medical Association Hospital, 1364-1 Tarobo, Miyakonojo, Miyazaki, 885-0002, Japan
| | - Atsushi Nanashima
- Faculty of Medicine, Department of Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, Japan
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Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2097363. [PMID: 27868061 PMCID: PMC5102704 DOI: 10.1155/2016/2097363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/04/2016] [Accepted: 10/13/2016] [Indexed: 12/12/2022]
Abstract
Portosystemic shunt (PSS) without a definable cause is a rare condition, and most of the studies on this topic are small series or based on case reports. Moreover, no firm agreement has been reached on the definition and classification of various forms of PSS, which makes it difficult to compare and analyze the management. The blood flow can be seen very similar to an electric current, governed by Ohm's law. The simulation of PSS using an electric circuit, combined with the interpretation of reported management results, can provide intuitive insights into the underlying mechanism of PSS development. In this article, we have built a model of PSS using electric circuit symbols and explained clinical manifestations as well as the possible mechanisms underlying a PSS formation.
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Cunha FA, Silva AL, Jacob MG. An uncommon cause of portal hypertension. BMJ Case Rep 2015; 2015:bcr-2015-212665. [PMID: 26385942 DOI: 10.1136/bcr-2015-212665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Poullos PD, Thompson AC, Holz G, Edelman LA, Jeffrey RB. Ischemic colitis due to a mesenteric arteriovenous malformation in a patient with a connective tissue disorder. J Radiol Case Rep 2014; 8:9-21. [PMID: 25926912 DOI: 10.3941/jrcr.v8i12.1843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ischemic colitis is a rare, life-threatening, consequence of mesenteric arteriovenous malformations. Ischemia ensues from a steal phenomenon through shunting, and may be compounded by the resulting portal hypertension. Computed tomographic angiography is the most common first-line test because it is quick, non-invasive, and allows for accurate anatomic characterization. Also, high-resolution three-dimensional images can be created for treatment planning. Magnetic resonance angiography is similarly sensitive for vascular mapping. Conventional angiography remains the gold standard for diagnosis and also allows for therapeutic endovascular embolization. Our patient underwent testing using all three of these modalities. We present the first reported case of this entity in a patient with a vascular connective tissue disorder.
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Affiliation(s)
- Peter D Poullos
- Department of Radiology, Stanford University Hospital, Stanford, CA
| | - Atalie C Thompson
- Stanford University School of Medicine, Stanford, CA ; University of California, Berkeley, School of Public Health, Berkeley, California
| | - Grant Holz
- Department of Radiology, University of California Davis, Sacramento, CA
| | - Lauren A Edelman
- Department of Pathology, Stanford University Hospital, Stanford, CA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University Hospital, Stanford, CA
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Athanasiou A, Michalinos A, Alexandrou A, Georgopoulos S, Felekouras E. Inferior mesenteric arteriovenous fistula: Case report and world-literature review. World J Gastroenterol 2014; 20:8298-8303. [PMID: 25009407 PMCID: PMC4081707 DOI: 10.3748/wjg.v20.i25.8298] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/08/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.
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Jeon DO, Park JS, Kim JE, Lee SJ, Cho HJ, Im SG, Kim ID, Han EM. [A case of traumatic inferior mesenteric arteriovenous fistula]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 62:296-300. [PMID: 24262596 DOI: 10.4166/kjg.2013.62.5.296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Inferior mesenteric arteriovenous fistula is rare and may be congenital or acquired. Affected patients present with abdominal pain, mass, or manifestations of portal hypertension and bowel ischemia. Until now, inferior mesenteric arteriovenous fistula due to trauma has not been reported. Herein, we report a case of a 53-year-old woman who had inferior mesenteric arteriovenous fistula considered to have originated from remote blunt trauma that was successfully treated by surgical resection of only the arteriovenous fistula without colectomy. To our knowledge, this is the first case of traumatic inferior mesenteric arteriovenous fistula.
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Affiliation(s)
- Dong Ok Jeon
- Departments of Internal Medicine, Surgery and Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea
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Kim IH, Kim DG, Kwak HS, Yu HC, Cho BH, Park HS. Ischemic colitis secondary to inferior mesenteric arteriovenous fistula and portal vein stenosis in a liver transplant recipient. World J Gastroenterol 2008; 14:4249-52. [PMID: 18636676 PMCID: PMC2725392 DOI: 10.3748/wjg.14.4249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Arteriovenous fistula (AVF) involving the inferior mesenteric vessels is rare, and the affected patients usually present with abdominal pain, mass, or features of established portal hypertension. Colonic ischemia is a less common and more serious manifestation of AVF. We report a case of ischemic colitis secondary to inferior mesenteric AVF in a patient who underwent a previous liver transplantation, subsequently developed portal vein stenosis, and then presented with acute lower gastrointestinal bleeding. He underwent percutaneous transhepatic placement of a portal vein stent and left colectomy.
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Superina RA, Alonso EM. Medical and surgical management of portal hypertension in children. ACTA ACUST UNITED AC 2006; 9:432-43. [PMID: 16942669 DOI: 10.1007/bf02738533] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The treatment of portal hypertension in children has undergone considerable evolution in the past decade. The treatment offered depends on the cause of the hypertension and the underlying health of the liver. The diagnosis of portal hypertension often can be made by the history and physical examination. Upper gastrointestinal bleeding in the presence of splenic enlargement is pathognomonic for portal hypertension. Bleeding and hypersplenism are the principal symptoms. Treatment of bleeding starts with confirming the diagnosis with esophageal and gastric endoscopy. The patient is admitted to an intensive care unit and started on intravenous octreotide. Banding or sclerosis of esophageal varices will result in cessation of the bleeding but not a permanent cure. A careful investigation for the cause of the portal hypertension should be done. This includes imaging studies of intra-abdominal arteries and veins, a liver biopsy, and liver function tests, including coagulation studies. For patients with extrahepatic portal vein thrombosis, early consideration should be given to surgical treatment with a meso-Rex bypass. Patients with liver disease should be treated for the underlying disorder and undergo regular endoscopic monitoring for recurrence of varices. Patients with well-compensated cirrhosis should be considered for selective surgical shunting, and those with advanced disease for liver transplantation. The benefit of long-term beta blockers in children has not been proven by clinical trials.
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Affiliation(s)
- Riccardo A Superina
- Division of Transplant Surgery, Children’s Memorial Hospital, 2300 Children’s Plaza, Box 57, Chicago, IL 60614, USA.
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Nemcek AA, Yakes W. SIR 2005 Annual Meeting Film Panel case: inferior mesenteric artery-to-inferior mesenteric vein fistulous connection. J Vasc Interv Radiol 2006; 16:1179-82. [PMID: 16151057 DOI: 10.1097/01.rvi.0000175327.10770.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Albert A Nemcek
- Department of Radiology, Northwestern Memorial Hospital, 251 East Huron, Chicago, Illinois 60611, USA.
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Oberti F. Comment prévenir et traiter les hémorragies par varices gastriques, ou ectopiques ou par gastropathie congestive. ACTA ACUST UNITED AC 2004; 28 Spec No 2:B53-72. [PMID: 15150498 DOI: 10.1016/s0399-8320(04)95241-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Frédéric Oberti
- Service d'Hépato-Gastroentérologie, Centre Hospitalo-Universitaire Angers, 49100 Angers
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