Presentation
Rectal bleeding. History of surgery and chemotherapy for frozen pelvis.
Patient Data
There is a fistula from the right external iliac artery to an ileal loop with a sizable amount of arterial bleeding. There is a cluster of adjacent small gas bubbles, some of which are perhaps either extraluminal or inside an enteroenteric fistula (traction of the medial ileal loop). Thrombosed blood in the ileum and colon is also seen.
The inferior vena cava and common iliac veins are flattened. The right common iliac vein does not opacify - thrombosed? compressed?
Yellow arrow pointing to the fistula between the external iliac artery and a loop of the ileum. Opacified blood can be seen inside the ileal lumen (inverted teardrop shape).
Case Discussion
The patient presented due to rectal bleeding.
History notable for "frozen pelvis" one year earlier: a large pelvic conglomerate occluded the right ureter and infiltrated the sigmoid colon wall and the sacrum, with retroperitoneal lymphadenopathy. The conglomerate was rigid and had to be manually separated from the iliac vessels and the infiltrated organs. The patient underwent a right nephrectomy with the removal of a cuff from the urinary bladder.
The histopathology was of poorly differentiated carcinoma and he subsequently underwent chemotherapy.
CT angiography was performed and showed an arterioenteric fistula between the external iliac artery and an ileal loop, notable for brisk arterial bleeding.
Two covered stents were placed in the right external iliac artery but the patient died the same day.
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