Iliac Arterioenteric Fistula Presenting as Ileus: A Catastrophic Late Complication of Pelvic Surgery and Radiotherapy
DOI:
https://doi.org/10.65495/eurjimr.2026.19Keywords:
Iliac arterioenteric fistula, Gastrointestinal hemorrhage, Pelvic radiotherapy, IleusAbstract
Background: Arterioenteric fistulas are rare but life-threatening causes of gastrointestinal hemorrhage, most commonly occurring after aortic or aortoiliac reconstruction. Iliac artery–enteric fistulas without prior vascular surgery are exceptionally uncommon and may be difficult to recognize, particularly in a radiation-altered pelvis.
Case Presentation: A 54-year-old male with prior low anterior resection and adjuvant chemoradiotherapy for rectal cancer presented with ileus-like symptoms two weeks after inguinal hernia repair. After initial improvement with conservative management, he developed sudden abdominal pain, hemodynamic collapse, and massive hematochezia. During colonoscopy, diffuse intraluminal hematoma and hemorrhagic content were observed throughout the lumen; however, no definite active bleeding source was identified. After the procedure, the patient developed hemodynamic instability, which progressed to hemodynamic collapse. Emergency laparotomy revealed massive hemorrhage from an arterial defect at the iliac bifurcation adherent to small bowel within a radiation-fibrotic pelvis, consistent with an iliac arterioenteric fistula/arterial erosion. Proximal vascular control and definitive repair were performed, along with extensive small-bowel resection and stoma formation.
Conclusions: Iliac arterioenteric fistulas can occur without prior vascular reconstruction and may initially mimic ileus, even in the absence of herald bleeding. Non-localizing endoscopy should not exclude the diagnosis in patients with abrupt deterioration. While endovascular techniques aid stabilization, open surgical repair remains essential when bowel compromise or contamination is present.
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