Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Stent graft treatment of an ilioenteric fistula secondary to radiotherapy: a case report

  • Jang, Joo Yeon (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine) ;
  • Jeon, Ung Bae (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine) ;
  • Kim, Jin Hyeok (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine) ;
  • Kim, Tae Un (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine) ;
  • Hwang, Jae Yeon (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine) ;
  • Ryu, Hwa Seong (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine)
  • Received : 2021.04.12
  • Accepted : 2021.06.07
  • Published : 2022.01.31
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Abstract

Fistulas between the arteries and the gastrointestinal tract are rare but can be fatal. We present a case of an ilioenteric fistula between the left external iliac artery and sigmoid colon caused by radiotherapy for cervical cancer, which was treated with endovascular management using a stent graft. A 38-year-old woman underwent concurrent chemoradiotherapy for cervical cancer recurrence. Approximately 9 months later, the patient suddenly developed hematochezia. On her first visit to the emergency room of our hospital, computed tomography (CT) images did not reveal extravasation of contrast media. However, 8 hours later, she revisited the emergency room because of massive hematochezia with a blood pressure of 40/20 mmHg and a heart rate of 150 beats per minute. At that time, CT images showed the presence of contrast media in almost the entire colon. The patient was referred to the angiography room at our hospital for emergency angiography. Inferior mesenteric arteriography did not reveal any source of bleeding. Pelvic arteriography showed contrast media extravasation from the left external iliac artery to the sigmoid colon; this was diagnosed as an ilioenteric fistula and treated with a stent graft. When the bleeding focus is not detected on visceral angiography despite massive arterial bleeding, pelvic arteriography is recommended, especially in patients with a history of pelvic surgery or radiotherapy.

Keywords

Acknowledgement

This study was supported by a 2019 research grant from Pusan National University Yangsan Hospital.

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