Arterio-intestinal Fistula Developing Post Colectomy for Local Recurrence of Cancer following Sigmoidectomy—An Autopsy Case Report—

Abstract

An arterioenteric fistula is a rare disease that has a high degree of urgency and severity. A 62-year-old woman presented with postoperative recurrence of sigmoid colon cancer. She underwent radical resection after bevacizumab-FOLFOX therapy for postoperative recurrence of sigmoid colon cancer. She was discharged home after surgery, but was brought to the hospital as an emergency due to hemorrhagic shock caused by heavy bleeding ; she died despite attempted life-saving treatment. The pathological autopsy showed that the patient died of exsanguination due to a left common iliac artery-colon fistula. It was suggested that suture failure at the anastomosis of the colon had potentially occurred, and that infectious inflammation caused by suture failure had spread to the dissected surface of the left common iliac artery, resulting in a left iliac artery-colon fistula. The time from onset to death was very short, and the patient was extremely difficult to save. Diagnosis of the anastomotic leakage was delayed due to atypical symptoms such as back pain and left inguinal pain. The temporary improvement of hemorrhagic shock further delayed interventions such as gastrointestinal endoscopy and interventional radiology. This case underscores the critical need for vigilance and prompt action in identifying and managing such complex presentations.