Laparoscopic sigmoid colectomy for transverse colonic varices due to an inferior mesenteric arteriovenous fistula

Taro Munechika; Keiichi Shiokawa; Issei Takeshita; Hisaaki Shimokobe; Kurumi Sahara; Yoshiko Matsumoto; Naoya Aisu; Gumpei Yoshimatsu; Suguru Hasegawa

doi:10.1186/s40792-024-01911-z

Laparoscopic sigmoid colectomy for transverse colonic varices due to an inferior mesenteric arteriovenous fistula

Surg Case Rep. 2024 May 3;10(1):112. doi: 10.1186/s40792-024-01911-z.

Authors

Taro Munechika¹, Keiichi Shiokawa², Issei Takeshita², Hisaaki Shimokobe², Kurumi Sahara², Yoshiko Matsumoto², Naoya Aisu², Gumpei Yoshimatsu², Suguru Hasegawa²

Affiliations

¹ Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka City, Fukuoka, 814-0180, Japan. munechitaro@gmail.com.
² Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka City, Fukuoka, 814-0180, Japan.

Abstract

Background: Colonic varices are a rare gastrointestinal anomaly often associated with portal hypertension. Arteriovenous fistula (AVF) in the inferior mesenteric artery (IMA) region is even rarer. Diagnosis and treatment of these entities present unique challenges, especially when the IMA is involved.

Case presentation: A 48-year-old man with a history of cholecystectomy presented with after a positive fecal occult blood test. Investigations revealed varices from the splenic flexure to the transverse colon and suspected AVF in the IMA region. Given the high risk and low efficacy of endoscopic and radiological interventions, laparoscopic sigmoidectomy was performed. This surgical approach successfully addressed both the AVF and the associated varices.

Conclusion: This case underscores the importance of surgical intervention for AVF and colonic varices in the IMA region, particularly when other treatment options pose high risks and have limited efficacy. The favorable postoperative outcome in this case highlights the effectiveness of carefully chosen surgical methods when managing such complex and rare conditions.

Keywords: Arteriovenous malformation; Case report; Colonic varices; Enteric arteriovenous fistula; Inferior mesenteric arteriovenous fistula; Surgical resection.