A Case of an External Iliac Arterio-ileal Fistula Caused by Pelvic Irradiation

Abstract

A 38 year-old woman with cervical cancer was performed a radical hysterectomy followed by adjuvant chemoradiotherapy at the department of gynecology in our hospital in September 2009. In March 2011, she was transferred to our hospital because of the sudden onset of massive melena and serious anemia. On the 2nd hospital day, a colonoscopy was performed and proved the radiation enteritis in the rectum to the sigmoidal colon. On the 3rd hospital day, she presented massive melena again and went into hemorrhagic shock. The dynamic CT proved an extravasation of a contrast medium into the small intestine, and urgent angiography was performed. Aortography showed a fistula between the left external iliac artery and the ileum. The primary closure of the fistula on the external iliac artery and partial resection of the ileum were performed. She was discharged on the 23rd postoperative day. Although arterio-enteric fistula (AEF) is well recognized as one of complications after aortic replacement for the cardiovascular surgeons, but for general surgeons, AEF is rarely known. AEF occurs owing to an aneurysm and irradiation, in addition to aortic replacement. AEF is often difficult to diagnose, and is a surgical abdomen that requires urgent treatment. We report our experience with case reports in the literature.