A Case of Refractory Ischemic Colitis Associated with a Mesenteric Arteriovenous Malformation Requiring Surgical Intervention

Abstract

Ischemic colitis is a condition caused by the combined effects of vascular factors and intestinal factors such as constipation or diarrhea, leading to impaired intestinal blood flow. It is usually managed with conservative treatment. In this report, a case of refractory ischemic colitis, caused by an inferior mesenteric arteriovenous malformation, and sigmoid colon cancer requiring surgical intervention, is presented. The patient was a 66-year-old man who presented with persistent diarrhea and abdominal pain. He was diagnosed with ischemic colitis and treated conservatively, but his condition did not improve. Contrast-enhanced computed tomography (CT) and angiography showed an inferior mesenteric arteriovenous malformation. Colonoscopy showed persistent edema from the splenic flexure to the rectum and sigmoid colon cancer. The final diagnosis was ischemic colitis due to inferior mesenteric arteriovenous malformation and sigmoid colon cancer (cT1bN0M0 cStage I). Open Hartmann surgery and D2 lymphadenectomy were performed, and there was no recurrence of symptoms postoperatively. This case suggests the importance of considering an inferior mesenteric arteriovenous malformation as a cause of refractory ischemic colitis and the need for surgical intervention.