Vasculo-Enteric Fistula A Case Report

Abstract

ABSTRACT
Case presentation: A 30-year old male presented with bleeding per stoma (colostomy)
which was established before one month as a result of multiple shell injuries to the buttock
and lower limbs. On admission, there was minimal bleeding per stoma and per rectum. He
was resuscitated, investigated and treated conservatively. A provisional diagnosis of false
aneurysm eroding the wall of rectum was made. One week later, he presented with
profuse bleeding and grade III shock, he was resuscitated and explored in an attempted to
control bleeding but we failed to find the source of bleeding. Damage control surgery was
done. Next day MRA was done to establish the source of bleeding, 72 hr later reexploration,
dissecting the fistula and control of bleeding was done.
Conclusion: Fistula between rectum and branches of internal iliac artery seems to be
very rare. In patients with clinical signs of bleeding per stoma, with history of trauma and
ligation of internal iliac artery bilaterally, suspicion of ischemia should be made, but one
month after first presentation, false aneurism and fistula should be considered in
differential diagnosis. In the presented case, it was possible that the injury which caused
pelvic hematoma and rectal injury also caused infection and erosion to both vessel and
rectal walls.