Arterio-intestinal fistula as a rare cause of recurrent bleeding from lower gastrointestinal tract. Case report. Diagnostic and therapeutic implications

Abstract

A case of 39-year-old female with mental retardation and over 2 years history of recurrent bleeding from lower gastrointestinal tract requiring repeated blood transfusions. The patient was admitted to the department of general and vascular surgery due to subsequent episode of bleeding from lower gastrointestinal tract. Initially the patient who had not agreed to any diagnostic and therapeutic procedures (including non-invasive ones) was treated with blood transfusions. When the respiratory failure occurred, the patient required mechanical ventilation. In abdominal ultrasonography hyperechogenic space was found in perienteric region with suggestion of perirectal haematoma. In abdomen and pelvis minor CT some contrast media was found nearby iliac internal artery with suggestion of extravasation to sigmoid colon. The aortography and arteriography of pelvic arteries was performed and oval luid space filling from internal iliac artery was revealed. During laparotomy a fistula between internal iliac artery and sigmoid colon was finaly discovered. A resection of sigmoid colon was performed, internal iliac artery was ligated and preternatural anus on sigmoid colon was formed. Primary (congenital) and secondary arterio-intestinal fistulas may be rare and difficult to diagnose causes of life threatening bleeding from lower gastrointestinal tract. Radiologic methods of vessels visualisation may play an essential role in diagnosis.