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<p>Arterioenteric fistula (AEF) is a&#xa0;rare but life-threatening condition that often results in fatal outcomes if not diagnosed and treated promptly. It occurs when an arterial vessel forms an abnormal connection with the intestine and can be classified into primary and secondary forms. Arterioenteric fistulas involving the external iliac artery and ileum are particularly rare, especially in the absence of prior vascular intervention. This case report details a&#xa0;77-year-old woman who presented with lower abdominal pain and hematochezia. Her medical history included pelvic vein thrombosis and uterine cancer treated with surgery and radiation 23&#xa0;years previously. Initial imaging revealed blood clots in the small intestine, and subsequent diagnostic testing identified a&#xa0;fistula between the right external iliac artery and the small intestine. The patient underwent successful interventional radiology to close the fistula, but developed severe complications, including mesenteric ischemia with colon necrosis, acute renal failure, and laryngeal recurrent nerve paresis on both sides. Following surgeries, including a&#xa0;total colectomy and ileostomy creation, and a&#xa0;prolonged stay in intensive care, the patient eventually stabilized. After extensive therapy, the patient was discharged without further complications. This case highlights the challenges of diagnosing and managing AEFs, particularly in rare instances where prior gynecological/oncological surgery and radiation therapy—which were more than a&#xa0;decade previously—are involved. Rapid recognition and intervention are essential to prevent fatal outcomes. The presence of nonspecific symptoms and a&#xa0;delayed diagnosis underscore the importance of early comprehensive diagnostic imaging and treatment.</p>

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Case report of a rare entity—spontaneous external iliac artery–ileum fistula

  • 期刊论文

  • 发表日期：

    2026年1月7日

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  • Daniela Schernthaner,
  • Mark Kammerer,
  • Sabine Wipper,
  • Reiko Wießner

摘要

Arterioenteric fistula (AEF) is a rare but life-threatening condition that often results in fatal outcomes if not diagnosed and treated promptly. It occurs when an arterial vessel forms an abnormal connection with the intestine and can be classified into primary and secondary forms. Arterioenteric fistulas involving the external iliac artery and ileum are particularly rare, especially in the absence of prior vascular intervention. This case report details a 77-year-old woman who presented with lower abdominal pain and hematochezia. Her medical history included pelvic vein thrombosis and uterine cancer treated with surgery and radiation 23 years previously. Initial imaging revealed blood clots in the small intestine, and subsequent diagnostic testing identified a fistula between the right external iliac artery and the small intestine. The patient underwent successful interventional radiology to close the fistula, but developed severe complications, including mesenteric ischemia with colon necrosis, acute renal failure, and laryngeal recurrent nerve paresis on both sides. Following surgeries, including a total colectomy and ileostomy creation, and a prolonged stay in intensive care, the patient eventually stabilized. After extensive therapy, the patient was discharged without further complications. This case highlights the challenges of diagnosing and managing AEFs, particularly in rare instances where prior gynecological/oncological surgery and radiation therapy—which were more than a decade previously—are involved. Rapid recognition and intervention are essential to prevent fatal outcomes. The presence of nonspecific symptoms and a delayed diagnosis underscore the importance of early comprehensive diagnostic imaging and treatment.