Related Experiment Video
Updated: Jul 29, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Inferior mesenteric arteriovenous malformation extending to splenic flexure colonic wall presenting with massive
Yumna Njoum1, Khaled Alshawwa2, Bashar Jaber2
1Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
Introduction And Importance:
An arteriovenous malformation (AVM) in the inferior mesenteric artery is a rare vascular pathology that accounts for 6 % of the causes of gastrointestinal bleeding. AVMs are typically classified as congenital persisting embryonic vasculature that link both systems and do not develop into arteries or veins [3], but they may also develop later in life. The majority of documented cases are iatrogenic after colon surgery.
Case Presentation:
Herein we describe a 56-year-old man who presented complaining of fresh blood per rectum with passage of clots not related to defecation with no previous similar episodes, he was found to have extensive inferior mesenteric branches AVM invading the colonic splenic flexure via Computed Tomography (CT) angiography following three non-revealing upper and lower endoscopies which was later managed surgically with left hemicolectomy with primary end to end colo-colic anastomosis.
Clinical Discussion:
Although AVMs seldom manifest in multiple sites through the gastrointestinal tract, it is more prevalent in the stomach, small intestine, and ascending colon, and very unusual to affect the Inferior mesenteric artery and vein and to extend to the splenic flexure colonic wall.
Conclusion:
Even if rare, inferior mesenteric AVMs should be suspected in a patient presenting with GI Bleeding with unrevealing endoscopies, where CT Angiography is to be considered.
Insights
Arteriovenous malformations (AVMs) in the inferior mesenteric artery are a rare cause of gastrointestinal bleeding. CT angiography is crucial for diagnosing these rare AVMs when endoscopies are inconclusive.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Arteriovenous malformations (AVMs) are rare vascular anomalies, often congenital, that can cause significant gastrointestinal bleeding.
- While AVMs can occur throughout the GI tract, they are particularly uncommon in the inferior mesenteric artery and splenic flexure.
- Iatrogenic causes, especially post-colon surgery, are a notable factor in the development of AVMs.
Observation:
- A 56-year-old male presented with rectal bleeding and clots, unresponsive to initial endoscopic evaluations.
- Computed Tomography (CT) angiography revealed extensive AVMs in the inferior mesenteric artery branches invading the splenic flexure.
- The patient had no prior history of similar gastrointestinal bleeding episodes.
Findings:
- The case highlights an unusual presentation of an inferior mesenteric artery AVM extending to the colonic splenic flexure.
- CT angiography proved effective in diagnosing the AVM after multiple non-revealing upper and lower endoscopies.
- Surgical management with left hemicolectomy and anastomosis was successfully performed.
Implications:
- Inferior mesenteric artery AVMs, though rare, should be considered in patients with obscure gastrointestinal bleeding.
- CT angiography is a valuable diagnostic tool for identifying these AVMs when standard endoscopic procedures are negative.
- Timely diagnosis and surgical intervention are critical for managing complex AVMs and preventing recurrent bleeding.
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