A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report

Abstract

Background Inferior mesenteric arterioportal fistula (APF) is rare as only 35 case reports in the literature. We herein presented a case of simultaneously double cancer in the rectum and stomach with inferior mesenteric APF, which is the first case report by searching using PubMed. Combination of interventional embolization and surgical operation seemed to be optimal treatment for avoiding postoperative complications and the curability. Case presentation A 66-year-old male with epigastric pain was admitted to a practitioner. He underwent a gastroscopy with biopsy, and cancer located in the lesser curvature of the gastric cardia was found. Enhanced CT did not reveal wall thickening of the stomach and distant metastases, but several swollen lymph nodes were observed in the right cardia. In the arterial phase, dilation of inferior mesenteric vein (IMV) and superior rectal artery (SRA) were noted, which raised suspicions of an arterioportal communication. Colonoscopy revealed a type 2 rectal tumor located 12 cm from the anal verge. The histological diagnosis of well-differentiated tubular adenocarcinoma was confirmed by biopsy. At a first step, we planned to perform a radiological embolization of inflow vessels to APFs except for SRA. Additionally, we determined the interval time of 1 month between the first low anterior rectal resection and the sequential gastrectomy for the purpose of decreasing portal pressure. The postoperative course was uneventful without hemorrhagic complications, and S-1 was taken internally 1 year as adjuvant chemotherapy for gastric cancer. The patient still lives without recurrence of this cancer with APF and portal vein thrombosis 2.5 years after the aforementioned surgeries. Conclusion Inferior mesenteric APF and/or arteriovenous fistula (AVF) would be consisted of the several inflow arteries as superior rectal, internal iliac, and median sacral arteries, and outflow veins as inferior mesenteric, internal iliac, and median sacral veins. To determine the therapeutic strategy for left-sided colorectal cancers with abnormal vessel communications of the pelvis, it is significant to comprehend distribution and component vessels of APF and/or AVF.

A Case of Refractory Esophageal Varices Caused by an Inferior Mesenteric Arteriovenous Malformation with All Portal System Occlusion Successfully Treated via Transarterial Embolization

“…Until 2021, only 40 cases had been reported [3,4]. Kai et al stated that AVFs could be easily confused with AVMs because there are no criteria for distinguishing the former from the latter [4]. In the current case, we defined a diagnosis as an AVM when the vessels directly connected to the IMA and IMV were numerous and fine nidus-like.…”

“…Inferior mesenteric AVFs/AVMs are rare. Until 2021, only 40 cases had been reported [3,4]. Kai et al stated that AVFs could be easily confused with AVMs because there are no criteria for distinguishing the former from the latter [4].…”

Trans-arterial embolization of a Yakes type IIb inferior mesenteric arteriovenous malformation: A case report and literature review for angio-architecture analysis

“…Six cases of embolization failure via the TA route were due to persistent or recurring symptoms in the short term [7 , 12 , 29] , deterioration of ischemia [19 , 20] , technical issues [21] , and AVM rupture after embolization [33] . Among the 9 cases of successful embolization via the TA route, our patient had frequent diarrhea, which disappeared after 6 months; 1 patient had paroxysmal abdominal pain after embolization [16] , which disappeared after a few days; and the remaining 7 patients had no complications after embolization and recovered well [11 , 13 , 27 , 32 , 34 , 35 , 40] . All 5 patients who underwent successful transvenous (TV) route embolization [10 , 14 , 26 , 28 , 31] developed no complications and recovered well ( Fig.…”

“…There were 22 cases of embolization, 2 of which were presurgical embolization to avoid bleeding during surgery [25 , 35] . Among all cases of curative-intent treatment, there were 20 embolizations, 6 of which failed (symptoms either did not improve or worsened) [7 , [19] , [20] , [21] , 29 , 33] .…”

“…Considering the clarity of available images for angioarchitecture analysis, we conducted a literature review of PubMed from 1988 to 2022 using the keywords “inferior mesenteric artery,” “arteriovenous malformation,” and “fistula” and found 39 cases. After excluding those without angiography [2] , those with poor imaging quality [3] , and those with an unclear relationship between the nidus and outflow veins in imaging examinations [4 , 5] , we conducted an angioarchitecture analysis of 33 cases [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] in addition to our own (34 total cases), as listed in Table 1 .…”